Market Analysis: Bariatrics 24 Product Focus: Seating & Positioning p. p. 30 A Penton Media Publication FOR BUSINESS LEADERS IN HOME MEDICAL EQUIPMENT www.homecaremag.com MAY 2011 Klingensmith HealthCare’s New Take on Helping COPD Patients p. 14 OXYGEN: Not for the Faint of Heart p. 36 My Biggest Mistake p. 20 HME owners know mistakes happen, and they can be costly REPORT p. 10 The Official Magazine of Medtrade Digital Edition Copyright Notice The content contained in this digital edition (“Digital Material”), as well as its selection and arrangement, is owned by Penton Media, Inc. and its affiliated companies, licensors, and suppliers, and is protected by their respective copyright, trademark and other proprietary rights. 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NEITHER PENTON NOR ANY THIRD PARTY CONTENT PROVIDER OR THEIR AGENTS SHALL BE LIABLE FOR ANY ACT, DIRECT OR INDIRECT, INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES ARISING OUT OF THE USE OF OR ACCESS TO ANY DIGITAL MATERIAL, AND/OR ANY INFORMATION CONTAINED THEREIN. ACCESS THE TOOLS YOU NEED TO INCREASE YOUR GEOGRAPHIC REACH. Count on McKesson to help you grow and expand your business. Increase your reach quickly to serve new patients without adding inventory, warehouse space or staff. Patient Home Drop Ship Deliver orders directly to your patients from our distribution center with your name on the packing slip. You’ll save on overhead, labor and shipping costs. Patient Specific Bulk Receive complete orders, individually packed, sorted and labeled by patient. You’ll never have to unpack, pick and repack most orders, and also reduce the need for on-hand inventory. National Distribution Network Extend your reach without expanding your footprint with our strategic network of 13 distribution centers. Deliver products to patients all over the country, quickly and efficiently. Let’s start building a stronger foundation for the future of your business today. Call to learn more at 800.446.6380 or visit HMEsolutions.mckesson.com. ©2011 McKesson Medical-Surgical Inc. Contents MAY 2011 VOLUME 34 | NUMBER 5 HomePage 8 ■ Working Down Denials With Sarah Hanna REPORT ■ Mood Swings at Medtrade Spring 10 ■ From uncertain to upbeat, life will be different. ■ Columns By Tyler Wilson ■ Washington Wit & Wisdom 44 Dear HME Provider GOOD THINKING G By Cara C. Bachenheimer ■ Sales Notebook 46 Behold the Payer Klingensmith HealthCare has a new line on helping COPD patients. By Susanne Hopkins AAHomecare Update 43 Improving Mobility Policy By Gail Walker Breathing Easier 14 HomeCare Web Poll HME Headlines By Louis Feuer, MA, MSW ■ Law School 48 More from PPACA By Jeffrey S. Baird, Esq. MARKET ANALYSIS M One Size Doesn’t Fit All 24 Bariatrics is a big growth market, but you’ve got to know—and show—the products. By Larry Anderson Departments ■ From the Editor 4 Notable & Quotable 6 ■ HME Products 49 ■ Industry Calendar 52 ■ Advertiser Index 52 ■ Classified Advertising 54 ■ PRODUCT FOCUS PR Seating & Positioning 30 SUCCESS FACTOR S Oxygen: Not for the Faint of Heart 36 Just check the crystal ball and place your bets. COVER STORY By Greg Thompson My Biggest Mistake 20 ON THE HOME FRONT O HME providers toiling in the school of hard knocks know mistakes happen, and they can be costly. 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POSTMASTER: Send address changes to HomeCare, P.O. Box 2100, Skokie, IL 60076-7800 USA. ©Copyright 2008 (by) Penton Media, Inc. All rights reserved. Penton Media, Inc. makes portions of our magazine subscriber lists available to carefully screened companies that offer products and services directly related to the industries we cover. Any subscriber who does not want to receive mailings from third-party companies should contact the Penton Media, Inc. subscriber service department at 800/441-0294 (U.S.), or 913/967-1707 (outside U.S.). PRIVACY POLICY: Your privacy is a priority to us. For a detailed policy statement about privacy and information dissemination practices related to Penton Media, Inc. products, please visit our Web site at www.penton.com. 2 | MAY 2011 | www.homecaremag.com From the Editor FOR BUSINESS LEADERS IN HOME MEDICAL EQUIPMENT A Penton Media Publication Hello, Medicare? H ave you tried to call the 1-800-Medicare line lately? VGM’s John Gallagher has, and he didn’t get very far. In fact, he said of several attempts to register a complaint, calling in is a frustrating and time-consuming dead end. “You are directed to at least 10 different stations,” Gallagher said recently. “The prompts are so ludicrous and then you get to a hold and you are on hold for 15 or 20 minutes. I have done it three times. I was hung up on twice, and when I did get somebody the third time, they put me on hold and never came back. “It’s a great system CMS has devised.” Gallagher thinks the number of prompts he went through might even be more than 10. “It just seemed to go on and on and on,” he said. “If I did get somebody, it was ‘Hold, please,’ and they never came back. Everything is set up to make sure you can’t get through.” Gallagher, VGM’s vice president of government relations, brought up the experience because he thinks that could explain CMS’ assertion that it got only 43 complaints about competitive bidding out of 54,000 calls. Industry advocates immediately questioned both figures, which agency officials included in a report on Round 1 at a meeting of the Program Advisory and Oversight Committee last month. Cara Bachenheimer, senior vice president of government relations for Invacare and a former PAOC member, said it was unclear what the 54,000 represented—all competitive bidding calls from the nine Round 1 CBAs or other Medicare calls, or what? The way CMS defines a “complaint” is also unclear, she said. “Their definition of a complaint is not the same as ours.” According to AAHomecare, CMS classifies some contacts, which can include calls about difficulty finding a contract provider or switching to less expensive equipment, as “inquiries.” “We look at it as 54,000 people calling in to express concerns, and only in nine competitive bidding areas,” said the association’s Walt Gorski, vice president of government relations and a member of the PAOC. “Imagine what is going to happen as the realities of competitive bidding set in and there is a ten-fold expansion in the next round.” Actually, Gallagher got farther than I did when I tried to call the Medicare help line. I don’t have a Medicare number (yet), and that’s the first thing the system asks for. Without one, I couldn’t get past the first prompt. That makes me wonder how family members or caregivers without a Medicare number, either the patient’s or one of their own, get through on the line, not just to complain about competitive bidding but to ask about anything. The process could be especially burdensome for an elderly Medicare beneficiary who is ill or upset, Gallagher pointed out. It seems like “they set up roadblocks to keep people from complaining,” he said. “If I am a caregiver, I should be able to call Medicare.” He suggested that providers mention the boondoggle of a system to their legislators as they campaign for support of competitive bidding repeal bill H.R. 1041. “Ask your congressman to ask a staffer to contact the 800 help line,” he said. Registering your own complaints about competitive bidding with your U.S. senators and representative—now there’s an important phone call you should definitely take the time to make. gwalker@homecaremag.com 4 | MAY 2011 | www.homecaremag.com 6151 Powers Ferry Road, N.W., Suite 200 Atlanta, GA 30339-2941 770/955-2500 www.homecaremag.com Publishers of HomeCareXtra, HomeCare Monday, the annual HomeCare Buyers’ Guide and Medtrade Daily Editor-in-Chief Gail Walker | 770/618-0121 gwalker@homecaremag.com Senior Editor Susanne Hopkins | 805/496-4642 shopkins@homecaremag.com Assistant Editor Stephanie Silk | 770/618-0127 ssilk@homecaremag.com Art Director David Ramares | 770/618-0145 dramares@homecaremag.com Contributing Writers Larry Anderson, Rebecca Grilliot, Denise H. 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Box 2100, Skokie, IL 60076-7800 USA. Accreditation simplified. The healthcare environment is complex but getting your accreditation doesn’t have to be. “operations” driven process that, unlike some other accreditation organizations, provides: The Compliance Team has been leading the movement to simplify the healthcare accreditation process since 1998. Each of our Exemplary Provider™ accreditation programs promotes healthcare delivery excellence through the implementation of sustainable quality improvement processes that are not difficult, time consuming, or costly to realize. Q Plain language quality standards that look at all aspects of your business Our Respiratory DMEPOS (CMS deeming authority) and Diagnostic Sleep accreditation programs provide a dramatically simplified, Q Packages combining DMEPOS and Sleep Center for a one-source accreditation solution Q Home Sleep Testing standards But most importantly, we simplify your Respiratory DMEPOS and Diagnostic Sleep accreditation while focusing on what matters most to patients—Safety-Honesty-Caring™. For more information, call 215.654.9110; email us at info@TheComplianceTeam.org or visit: www.TheComplianceTeam.org. An accreditation organization. Notable& Quotable FOR BUSINESS LEADERS IN HOME MEDICAL EQUIPMENT EDITORIAL ADVISORY BOARD Cara C. Bachenheimer Senior Vice President, Government Relations, Invacare Corp. Dexter Braff President, The Braff Group Jane W. Bunch CEO/President, Jane’s Healthcare Consulting Neil Caesar President, Health Law Center Alison Cherney President, Cherney & Associates, Inc. Cindy Ciardo CEO, Knueppel HealthCare Services, Inc. Mary Ellen Conway President, Capital Healthcare Group C-SPAN Louis Feuer Competitive Bidding Still a ‘Bad Deal’ A s thousands of HME providers and others met at Medtrade Spring in Las Vegas—many trying to figure out how to survive under competitive bidding—across the country in Washington Rep. Jason Altmire, D-Pa., delivered an April 14 floor speech against the program in the House of Representatives. Following its problem-plagued two-week implementation in 2008, Altmire helped introduce legislation to redesign the bidding program and delay its start for 18 months. “Critical flaws in the initial bidding process produced fewer competitors, fewer home care services and a substantial decrease in the quality of care offered to seniors and individuals with disabilities,” he said. In his four-minute oration, the Pennsylvania congressman said “it became clear that CMS did not foresee the unintended consequences that could result, including the possibility that patients could lose personal relationships they’ve developed with their local provider, in turn compromising their quality of care. Or the possibility that small suppliers, which make up well over 90 percent of the nation’s medical equipment providers, would not be able to compete in the new market.” In March, Altmire and Rep. Glenn “GT” Thompson, R-Pa., introduced H.R. 1041 to repeal competitive bidding entirely. In the first few months since the program’s re-implementation in January, Altmire said, “the worst fears expressed by patients, providers and members of Congress from both sides of the aisle have been realized. It’s clear that despite the delay, the direction from Congress, no significant improvements have been made to the program or the process. 6 President, Dynamic Seminars & Consulting Kevin M. Gaffney, CEM Group Show Director, Medtrade and Medtrade Spring, Nielsen Business Media Lisa Getson Executive Vice President, Apria Healthcare Sarah Hanna Vice President, ECS Billing & Consulting Schuyler Hoss President, Northwest Healthcare Management Seth Johnson Vice President of Government Affairs, Pride Mobility Products Corp. Mario Lacute President, Seeley Medical, Inc. Miriam Lieber President, Lieber Consulting Simon Margolis Executive Director, National Registry of Rehabilitation Technology Suppliers Terry Pageler President, PowerCore, Inc. Sheldon “Shelly” Prial Prial Consulting Darren Tarleton President and CEO, Mobility Warehouse “Providers who have served beneficiaries for years are closing their doors and patients have been left confused and unsure where to turn for their care.” Wallace Weeks While Altmire said CMS’ recent six-month delay of Round 2 (until the summer of 2013) is a good sign, “it doesn’t do anything to help the beneficiaries and small businesses that have already been negatively impacted by Round 1.” Colette Weil Stated Altmire, “The program continues to be a bad deal for seniors and small business owners.” Cliff Woolard | MAY 2011 | www.homecaremag.com President, Weeks Group Managing Director, Summit Marketing President/CEO, Home Med-Equip Co. Give patients a healthier dose of quality care with 4G. With the blazing speed of 4G and unlimited 4G data, it’s possible to cut down on time-consuming administrative work and devote more time to personalized home care. That’s because everything—from running healthcare apps to videoconferencing to accessing patients’ files away from the hospital—goes that much more quickly. Only on the Now Network.™ sprint.com/4G 1-800-SPRINT-1 (1-800-777-4681) Sprint 3G/4G USB U600 “Sprint showed the biggest improvement in customer experience across 14 industries.” –Forrester Research Report: Customer Experience Index 2010 May require up to a $36 activation fee/line, credit approval and deposit per line. Up to a $200 early termination fee/line applies. Coverage is not available everywhere. The Sprint 4G Network reaches over 70 markets and counting, on select devices. The Sprint 3G Network reaches over 271 million people. See sprint.com/4G for details. Not all services are available on 4G, and coverage may default to 3G/separate network where 4G is unavailable. Offers not available in all markets/retail locations or for all phones/networks. Pricing, offer terms, fees and features may vary for existing customers not eligible for upgrade. Other restrictions apply. See store or sprint.com/4G for details. ©2011 Sprint. Sprint and the logo are trademarks of Sprint. Page Check the HomeCare Monday archives at HomeCareMag.com for these and other industry headlines: • • • • • • POLL Have you had to add staff to comply with the growing number of audits (CERT, RAC, ZPIC, DME MAC, etc.)? Yes Round 2 Could Include More Products—Lots More No 8% 3% The proliferation of both pre- and post-pay audits is threatening my business Audit Situaton: ‘Worst I Have Ever Seen’ 89% 527 votes from April 1 to 29 ■ To vote in HomeCare’s Web poll, visit www.HomeCareMag.com MED’s Pederson: O&P Might Be Just What the Doctor Ordered • • • • • • • • WEB Working Down Denials Federal Buget Fight Throws Another Wrench into HME Works WITH SARAH HANNA DEN IED A6243 AAHomecare Survey: Mobility Providers Strugging to Adjust Hydrogel dressing Rosy Picture of Round 1 Shows CMS ‘Disconnect,” HME Advocates Say PAOC Speakers Give CMS Another View of Competitive Biding New Survey on Costs for Complex Rehab Providers AARC Endorses H.R. 1041 HomeCare Poll: Majority of HME Providers Want Out CMS Proposes Changes to Direct Solicitation Rule BCBS of South Carolina to Buy CGS Government Moves from Pay-andChase to Guarding the Henhouse Sebelius, Berwick Announce ACO Initiative www.HomeCareMag.com A ccording to analysis by RemitDATA, the A6243— hydrogel dressing, wound cover, sterile pad, each—has an overall denial percentage of 19.4. To help reduce this high denial rate, providers need to analyze what’s going on with their A6243 claims. One of the main reasons for denial of this HCPCS code is the COB15: The authorization number is missing, invalid, or does not apply to the billed services or provider. This denial reason code applies to supplies that were delivered and billed to Medicare while a patient was receiving services from a home health agency (HHA). To reduce this denial, look at how you are processing surgical dressing orders and gaining information about who is involved in the care of the patient. HME intake staff need to understand that surgical dressings fall under the home health prospective payment system. Under the PPS, an HHA must bill for all home health services except DME. The law requires that all home health services paid on a cost basis be included in the PPS rate, so it will include all nursing and therapy services, routine and non-routine medical supplies and home health aide and medical social services. An HHA is responsible for billing Medicare for all supplies that are categorized as surgical dressings, urological and ostomy while the patient is under their care. If a supplier bills for these products and the patient is under the care of an HHA, then the supplier would receive a B15 denial code with a remark code of N70 (consolidated billing and payment applies). Your intake personnel must ask whether the patient is utilizing home health services upon referral, especially when the referral is received from a wound clinic, hospital, rehab facility or nursing facility. Those types of facilities usually discharge patients who require Sarah Hanna is a reimbursement consultant and vice the services of an HHA. president of ECS Billing & Consulting, Tiffin, Ohio, speNote, however, that when asking a cializing in proper billing protocols, Medicare coverage guidelines and billing office procedures. You can reach patient or caregiver if an HHA is inher at 419/448-5332 or sarahhanna@bright.net. volved in the patient’s care, they may not understand the meaning of “home health agency” or “HHA.” If that is the case, the intake employee will have to ask more creative questions to determine whether home health is involved. If an HHA is assisting with care for the patient, then you need to notify that HHA that all dressing supplies will be billed to the HHA due to PPS. Training intake personnel on PPS and the HHA connection, as well as going the next step in gaining the information, should help in the reduction of your COB15 denials for A6243. Based on anlysis of Medicare claims for RemitDATA customers during the fourth quarter of 2010. The average DSO for A6243 claims is 43 days. Source: RemitDATA, 866/885-2974 or www.remitdata.com 8 | MAY 2011 | www.homecaremag.com My Name: Ron Richard My Occupation: Former CEO, SeQual Technologies Current VP/GM of Respiratory for the combined CAIRE & SeQual families Our industry has been hit with some challenges. By combining the forces of CAIRE Medical and SeQual Technologies, we believe we'll be stronger than ever... Together, we continue to be a stable source for your business' oxygen needs. Our strengths are providing quality products and superior patient outcomes. OUR PASSION OUR OXYGEN SOLUTIONS Combined, we have the leading POC and the strongest LOX equipment on the market today. Our future product profile, coupled with current product development, creates a one-stop-shop for all HME respiratory needs. We deliver durable products, quality customer service and a knowledgeable sales force. We look forward to providing innovative solutions and revolutionary products that focus on protecting your investment, your patients and your bottom line. CREATE BETTER OUTCOMES. Combined With You In Mind. The Art Of Oxygen. RON0111 800.482.2473 Mood REPORT As the show floor opened at Medtrade Spring, shoppers combed the aisles on the hunt for products and services to help boost business. W hen Chris Kinard asked Medtrade Spring attendees to describe the HME industry’s current condition in one word, some of the responses he got were “catastrophe,” “chaos,” “uncertainty,” “change” and “craziness.” Those answers, said Kinard, market analyst for software vendor QS1, reminded him of the old “Hee Haw” TV show song: “Gloom, despair, and agony on me, Deep, dark depression, excessive misery. If it weren’t for bad luck, I’d have no luck at all, Gloom, despair, and agony on me.” “When I think about the HME industry, this is the song we’re all singing, and for the life of me I can’t figure out why,” Kinard 10 | MAY 2011 | www.homecaremag.com told his audience in a conference session on retail technology. “You can choose to speak an absolute curse over yourself and your business by walking around with this black cloud, but there are ways to overcome it. “I’ve never been more convinced about the opportunities in our industry,” Kinard continued. It’s just that working through exactly which opportunities fit your business will take some effort, he said, whether it’s committing to HME retail or through some other avenue. That’s what attendees at the annual spring trade show, held April 12-14 in Las Vegas, were trying to figure out. More than 320 exhibitors, including some 70 first-timers, were there to help. In only a few examples from the Expo floor—3,500 square feet bigger than last year’s, according to show officials— VirtuOx introduced its Freedom wireless oximetry platform, which company officials say could shave up to $75 off a provider’s cost per test by lessening the number of visits to a patient’s home. Pride Mobility rolled out its Rental Ready program to help providers transition to the rental environment Kinard post-elimination of the first-month purchase option From uncertain to upbeat, life will be different Swings A steady stream of attendees stopped by the H.R. 1041 “command center” at the AAHomecare booth to send messages to legislators about competitive bidding. at Medtrade Spring BY GAIL WALKER Don’t miss for power wheelchairs. The company’s Jazzy Select Elite, for example, includes a color-through shroud that won’t show scratches, a black seat with replaceable foam and vinyl and controller guards to protect the chair from daily wear and tear. “It’s all the features that can make it easier for the provider to put the chair back out if it comes back in,” said the company’s Joe Chesna, national sales director, standard power. Numerous software makers offered new features to help providers fix their weak spots, pick up speed, increase efficiency and generally manage better. “We’re finally starting as business owners to see that if we are going to continue not only to survive but to thrive in this industry, we’re going to have to go back to the drawing board and ask, ‘What are we doing and why are we doing it?’” said Kinard. Most show-goers were considering that ques- Medtrade 2011 Oct. 24-27, 2011 tion from the perspective of competitive bidGeorgia World ding, the topic that drew the most interest on Congress Center, Atlanta the conference schedule. Some providers said For information: the January implementation of Round 1 shocked www.Medtrade.com them into coming to grips with the program, although they were still dreading its effects. “Honestly, it is a much darker picture than what I anticipated,” said Jon Mayfield, regional sales manager of Central Health Services, Shawnee, Okla. “There are lots of fears in our area because Oklahoma has not experienced any Round 1 bidding, so the horror stories that we’ve heard have mainly been from publications. Hearing some first-hand experience, it hits it home a little bit harder as far as what we have to do as a company to prepare.” www.homecaremag.com | MAY 2011 | 11 Heard at the Show While sessions on competitive bidding drew the biggest interest at Medtrade Spring, the menace of Medicare audits was another hot topic, as was the way more upbeat opportunity in HME retail. Here’s what some attendees at the show had to say: REPORT “I’m here mainly to find out what people in Round 1 are experiencing so we can gauge how to go forward in Round 2 … Depending on what the bid rate is [will determine] whether or not we’re going to actually sign, even if we get selected to sign. We diversified four years ago into retail, and that’s where we’ve been trying to go. We’re at the point now where if we didn’t have a Medicare contract, there would be a lot of layoffs, but I think we would survive.” —Brad Maurer, Freedom Medical Supply, Henderson, Nev. “I’m in Round 2 of competitive bidding as the owner of a small durable medical equipment company in Porterville, Calif. It’s scary. You’ve to figure it out. You have no choice. If you do Medicare you have to bid, or else I don’t see how you’d stay in business.” —Janet Round, RN, CWCN, CWS, AWCS Medical, Porterville, Calif. “We are a multiple-location company with a location that is falling into a competitive bidding area for Round 2, and part of the reason why we’re here … is to get some idea as to what we can do to help better prepare for the bidding process as well as hear about ways to weather the storm. Honestly, it is a much darker picture than what I anticipated. There are lots of fears in our area because Oklahoma has not experienced any Round 1 bidding, so the horror stories that we’ve heard have mainly been from publications. Hearing some first-hand experience, it hits it home a little bit harder as far as what we have to do as a company to prepare.” ResMed took the honors as the show’s best booth for its streamlined design and use of color. —Jon Mayfield, regional sales manager, Central Health Services, Shawnee, Okla. “I see [retail] as the future of the HME business. I don’t think the other model is going to survive.” —Laura Berry, president, Soundview Medical Supply, Seattle, Wash. “I’ve been in this industry for over 30 years and this is the scariest time. We have worked hard, but reimbursementwise and with other things like audits, I think that the government is so aggressive these days that I don’t know that they really care whether you try hard to be perfect.” —Jan Wallace, vice president of business administration, Performance Home Medical, Kent, Wash. “Everybody is concerned with competitive bidding and Round 2 being implemented and what it is going to do to their business. Medicare only makes up 18 percent of my revenue so it’s not a big revenue stream for me, and I’m not as concerned about whether I bid or don’t bid … I can come to Medtrade and look for good pricing instead of being worried about where my business is going to be in six to 12 months and about whether I will be open for business or go out of business.” — Darren Tarleton, president and CEO, Mobility Warehouse, Stockbridge, Ga. “The thing that concerns us most is competitive bidding, so we’re trying to get ready for Round 2. I wouldn’t say we are scared, but we are concerned and hesitant about it because we’re thinking about our profits. We are just trying to make sure we’re up to date on everything, and we’re also looking at all the new products coming out to try to bring up our revenue.” —Azania Salazar, Performance Excellence Medical, Houston, Texas 12 | MAY 2011 | www.homecaremag.com While the introduction of H.R. 1041 has reenergized the industry’s grassroots effort to repeal the bidding system, providers who have already moved into retail or moved away from Medicare had a more upbeat take on the future. “My philosophy on retail is that it’s something you can use to leverage whatever else you do. Our plan is to perhaps take minimal Medicare reimbursement just to get in contact with that consumer and introduce them to all the new technology that’s out there,” said Jim Greatorex, president and CEO of Black Bear Medical, Portland, Maine. “At Medtrade, every year it’s exciting because we see nothing but opportunity. When we shop, we get to look at all these Providers packed conference sessions on competitive bidding, like this one on submitting Round 2 bids from VGM’s Mark Higley. Tough Numbers “Life was pretty good on Dec. 21, 2010,” Geller suggested doing some “guerilla said John Geller, vice president of 61-year-old math” to get an idea: For any products you Medical Service Co. in Cleveland. “I put my are interested in for Round 2, take the exhead down on the pillow that evening and isting competitive bidding prices now in under Competitive when I woke up on Jan. 1, no question it effect from any one of the nine CBAs. was a new day.” “Subtract that amount from what you Bidding Geller, whose company was awarded are currently being paid,” Geller said. multiple contracts in three competitive bidApply the difference to revenues from ding areas in the Round 1 rebid, said management thought that product for current patients from January through it was prepared for the start of the program. But he called March, and multiply by four. “That’s the annual impact what it has encountered since the bid’s Jan. 1 implementaof lost revenue you’ll have,” he explained. tion the “triple witching hour,” citing a 33.5 percent reduction Then begin to prepare yourself for how you’re going to in oxygen reimbursement, the mounting pressure of audits live under those bid rates, he said. “How will you change and, on top of that, “deductibles season.” your business structure to be able to afford to exist under “Roughly 100 days into it, I can’t tell you yet we’re a survithose rates?” vor,” Geller said April 12 at a Medtrade Spring session called His advice to providers who will be caught “Round 1 Lessons Learned.” While some probably breathed a up in Round 2? “Stash your cash,” Geller said. sigh of relief that Round 2 will be delayed by six months, he “I cannot tell you how important that is. For cautioned that delay will not soften the impact of the bidding those of you who still have cash available, zip program on any company’s business. up your pockets and hang on to it, because In the Cleveland CBA, he noted as an example, payment you’re going to need it.” Geller for an E1390 oxygen concentrator dropped from about $175 Session moderator Miriam Lieber said that to $103 under that CBA’s bid rates. “How do you provide advice is important for all providers because “everywhere services having a price reduction from $175 to $103?” Geller you turn you need additional cash” to defend against unasked the audience. “How do you make it work?” knowns in the industry’s rapidly changing environment. Questions like those are what providers in Round 2 need to “The truth is, each and every one of you is actually figure out, he said. “In competitive biding, there’s going to be involved in competitive bidding,” said Lieber of Lieber Cona significant price reduction from what you’re currently being sulting, Sherman Oaks, Calif. “Whether you like it or not, it paid. You need to understand what it’s going to cost you.” is impacting you.” AAHomecare officials lend a hand at Medtrade Spring’s official ribbon-cutting. From left, Tyler Wilson, president and CEO; Show Director Kevin Gaffney; Sue Mairena, COO; Joel Marx, chairman; and Robert Steedley, vice chair. New Product Pavilion Based on Winners attendee votes, the winners were: Innovation Award VPOD Freedom wireless oximetry device Virtuox Merit Award Sneaker Walker Glides Drive Medical Providers Choice Award Sami the Seal nebulizer Philips Respironics new entrepreneurs that have new technology that could be in categories we feel people are willing to pay for. The one thing our industry has that we’ve got to remember is that we have demand,” Greatorex said. “It’s nevernding. We’ve got to figure out how to capitalize on that.” “Providers need to see that they can plan not to be in the Medicare business,” said Rose Schafhauser, executive director of the Midwest Association for Medical Equipment Services (MAMES). “Even if they do get a contract [under competitive bidding], life is going to be different, so they need to start planning now. Schafhauser “There are so many things to look at,” Schafhauser said. “Could you go into home modification? Retail? Internet sales? Too many providers are making the basic assumption that they will get a contract, but if you do that, you’re still putting all of your eggs in the Medicare basket.” The lesson, said long-time industry champion and eternal optimist Sheldon “Shelly “ Prial, who has attended Medtrade with bride Thelma for 30 years, is that “the time has come to forget how you did business in the past and learn how to do business today. “There are ideas here that you can use,” said Prial. “It’s time to get up off your derriere and go to work to maintain your business, maintain your customers and maintain your sanity.” www.homecaremag.com | MAY 2011 | 13 Good Thinking Klingensmith has a new line on helping COPD patients Breathing Easier F By SuSanne HopkinS or Klingensmith HealthCare, the important factor in a patient’s hospital-home equation is the DASH in between. The Ford City, Pa.-based company is in the process of reinventing itself—and that DASH is a vital component. DASH stands for Discharge + Assessment & Summary @ Home, a program Klingensmith began in 2009 as a means of remaining viable in an increasingly difficult environment for home medical equipment providers. 14 | May 2011 | www.homecaremag.com A focus on chronic disease management for COPD patients has led Klingensmith HealthCare to a new level—and a new future. “We no longer define ourselves as a [durable medical equipment company],” says Dan Easley, senior vice president of sales. “We are this chronic disease management company. We are well planted in the home. What we have to do is a better job of defining what we can do in the home. With all these chronic disease management patients coming down the pike here, you’ve got to rely on what you can do in the home.” In a perilous HME world fraught with tsunami-sized changes such as competitive bidding and threats such as audits and constant cuts in reimbursement, it is important for HME companies to be forward-thinking, says Klingensmith’s Kim Wiles, BS, RRT, vice president of respiratory services. “As a DME company, you are forced to look outside the box, to look at health care reform and position yourself to [adjust to] how that is going to look in the future,” she explains. How that future looked to Klingensmith was not like a traditional HME company. “In the DME world, we are always worried about how we can get it there cheaper and faster,” Wiles says. “But there are other payers out there who are looking for more than that. We really need to look at how we can bring value to them. “The future of home care is beyond DME,” she adds. “As an industry, we really need to look outside that box. Going down the road, it is really chronic disease management.” Taking a Breath Klingensmith started out on this road two years ago. It wasn’t an unusual path—with 150 employees and six locations serving the western portion of Pennsylvania as well as northern West Virginia and eastern Ohio, the company has made a name for itself through its endeavors. Since its beginning as a pharmacy in the 1940s, the company has constantly reinvented itself. For 30 years, it has been a traditional full-service HME company, adding and subtracting equipment and services as needed. Both Wiles and Easley, founder of Inspired Technologies and developer of a conserving device, were initially brought on board to enhance the company’s respiratory services sector. Respiratory services has since become one of the provider’s key strengths. So it was natural, with competitive bidding looming along with further cuts to oxygen, that Klingensmith would take at look at that area. It quickly became clear that most of the company’s respiratory patients had chronic obstructive pulmonary disease, a condition that often resulted in repeated hospitalizations. Since its beginnings as a pharmacy in the 1940s, Klingensmith has constantly reinvented itself. The company currently has six locations serving portions of Pennsylvania, West Virginia and Ohio. one else, could help assess a patient’s risk factors and medical status. “What you really want to understand,” Easley says, “is what types of services you can wrap around that patient as a valueadded approach that gets way beyond providing equipment. How can we better take care of the people in the home so they can better manage their disease?” “We thought about aligning ourselves with the patient,” Wiles adds. “Then you have a whole different perspective on the value you drive and what your business definition is. The patient is the center. It drives everything you do.” So Wiles, Easley and their team set out to explore possibilities for a continuum of care that would boost the patient’s quality of life, expand Klingensmith’s reach and aid payers. They quickly realized they needed a way to measure patient progress and outcomes. “You can only imagine how many studies we looked at,” says Wiles. “The first year we were looking at what was working in England, what was working in Italy, what was working in the U.S.,” says Easley. “There was no silver bullet out there.” So, they wrote their own software with 100 different question sets to assess patients. “The respiratory therapist goes what types of services you can wrap around that in and it is not, ‘Do you underpatient as a value-added approach that gets way beyond stand how to use your equipproviding equipment. How can we better take care of the ment,’” Wiles says. “We ask, ‘What people in the home so they can better manage their disease?” do you want to be able to do at the —Dan Easley senior vice president of sales end of 30 days?’ [The answers] are something like, ‘I want to go to the movies with my grandchildren’ or “What we realized is that we had this huge intersection be- ‘I want to go shopping.’” tween the dozen [respiratory therapists] working under Kim While the assessment also includes clinical goals and risk and holistic management of the patients,” says Easley. “We factors, the patient goals are vital. had to get away from just understanding how to deliver oxy“If you didn’t have patient buy-in, your results were flat in gen to determining how that patient uses oxygen and how to the water,” Easley says, adding that typically, patient care is a manage the disease.” lot about negative reinforcement and how the patient is failing In other words, Klingensmith RTs and technicians were on to perform to standard. the front lines. They were in the homes of the patients, while “We wanted to get away from that equipment orientation,” hospitals and physicians were not, and they, more than any- Wiles says. “Now, we are all striving to meet that goal with the What you really want to understand is 16 | May 2011 | www.homecaremag.com The respiratory team realized that since its RTs and technicians were in the homes of its patients—while hospitals and physicians were not—they could help assess a patient’s risk factors and medical status. As a traditional full-service HME company, Klingensmith has added and subtracted equipment and services as necessary over the years, so its new respiratory endeavor is not such an unusual departure. patient—the hospital, the RT, the company. It’s patient-centered versus equipment-centered. “It is,” she adds, “beyond a postcard and a phone call.” The rubber hit the road in December 2009, when DASH was finally launched. “We did three different visits [to each COPD patient] in the first 30 days,” Easley says. Those visits by a technician and a respiratory therapist were supplemented by telephone calls from a patient care coordinator to the patient. “In total, there were 18 contacts in those first 30 days,” he says. As intense—and costly—as that attention appears to be, it was critical, Easley and Wiles contend, because Klingensmith personnel were able to identify and help ameliorate risk factors, as well as work with the patients to improve their performance. The result: Hospital readmissions dropped dramatically. Of 400 patients in the DASH program since its implementation, the re-hospitalization rate has dropped by 75 percent, Easley says, from 24 to 26 percent to 4 percent. Those are serious numbers that could garner a hospital’s attention. Tucked away in the legalese of the Patient and Protection Affordable Care Act is a provision that, effective in October 2012, Medicare can either reduce or withhold payments from hospitals at which patients have been readmitted within 30 days of their release. Under that provision, a 20 to 30 percent readmission rate for COPD could cost hospitals a total of about $50 million, Easley says. If a provider can prove its services result in a much lower rate, hospitals might well seek it out. “We are really now getting the ear of a lot of hospitals and a lot of payers because 2012 is right around the corner. It’s now critical. You can no longer spin the lottery wheel and pick the preferred provider of the day because the hospital is on the hook for that readmission in 30 days.” The data has been a key selling point, Easley and Wiles say. “Payers are all about data,” Easley says, “so we made sure we had that data before we talked to them … The response has been fabulous. They don’t have to do this program themselves.” For Klingensmith, the data has another value. It can pinpoint the possibility of offering new services, identify risk factors and alert the team to the impacts of missing something in patient care or not treating an issue. “Every month we look at the data—what are the misses, what’s the problem with the miss,” Wiles says. “It is a program that evolves daily, and looking backward over your six months of data gives you a lot of perspective as well.” The Next Step Klingensmith hasn’t stopped at DASH. In March of this year, it took the next step in its plan to focus on chronic disease management. The company opened a spin-off, Klingensmith Critical Care, a home health agency. Why? “Two reasons: KCC is an existing avenue to offer home respiratory services (DASH) and be paid via the HHA benefit,” says Wiles. “Secondarily, KCC offers us the opportunity to expand the impact of DASH by including clinical nursing for the other co-morbidities encountered, and the [occupational therapist/ physical therapist] services allow for early pulmonary rehab activities to be begun.” There is another plus to having an HHA, she says. “We also have the advantage of respiratory therapists being utilized in KCC, which is not a recognized profession in the eyes of [the Centers for Medicare and Medicaid Services], therefore not reimbursed. For this reason, it is rare to find an HHA employing a respiratory therapist. We feel the respiratory therapist is key in keeping the COPD patient out of the hospital. They are the experts in lung disease management, and now, with the added ability of the nurse and other professions, we are truly working as a coordinated team for the patient.” She says Klingensmith is not planning to be a “full-blown HHA,” but having that inherent clinical expertise reassures the respiratory patient that the company has the ability to take care of him or her. So how does this pay off for the provider? It is, after all, a costly program to undertake, Easley and Wiles say. “It’s multiple thousands of dollars,” Easley admits. “We made the decision not to be profitable or to be barely profitable for two years to fund it.” KCC is the answer to the recoupment-of-expenses question. “Expenses for the development of the software, hardware, additional RTs and marketing materials will be recouped through the revenues of KCC and, later, via contracts for clinical www.homecaremag.com | May 2011 | 17 respiratory management services with payers,” Wiles explains. For example, Easley says, many Medicare Advantage plans have initiated quality improvement bonuses, so by putting together a best-practices program for COPD management, Klingensmith could enhance the MAPs’ revenue and earn some bonus bucks as well. nering as a DASH/COPD Center of Excellence and correlated each 1 percent point gain in share as generating $1 million in revenue.” With that formula, the stunning drop in readmissions that the DASH program is recording could save one Klingensmith area hospital system $4.5 million to $6 million, and $1 million to $2 million for individual hospitals, the company estimates. Already, Klingensmith is seeing some very positive results from DASH, Wiles and Easley say. “We are seeing double-digit, topline growth,” Easley says. “We are seeing that leveraged into we are always profitability. We are seeing COPD patients havworried about how we can get it there cheaper and faster. But there are other payers out there who ing a net worth to us that is two-and-a-half times what it was before.” are looking for more than that. We really need to That’s encouraging, because Klingensmith look at how we can bring value to them.” doesn’t plan to stop with COPD. —Kim Wiles BS, RRT, vice president of respiratory services Wiles says that the company’s goal is eventually to provide disease management for congestive heart failure patients, etc. But that’s down Also, he continues, “Hospitals have shown us how to go the road; first, Klingensmith wants to perfect the COPD disease beyond cost avoidance. It is more revenue enhancement. management system. Any program they can look at that enhances revenue is es“We’ve got our data behind us, our validation behind us pecially attractive.” and a couple of studies coming out,” Easley says. “We don’t Easley says Klingensmith actually “identified the COPD really hit full stride until 2012 to 2014, when all these things market share for each hospital in western Pennsylvania, tar- you read about in health care reform come to pass. When geted the opportunities to gain COPD market share by part- 2012 hits, we’re there.” In the DME world, n tio en M Targeted Joint Stimulation Cumulative and combinational treatments 10-week study preformed with positive results :: the device // PATENT-PENDING // APPROVED // MEDICARE APPROVED // MEDICARE CODED (HCPCS E0762) arthritis therapy sleep system Contact us today to learn more. 800.239.7880 or on the web at www.jstim.com 18 | May 2011 | www.homecaremag.com , ad f of Designed for sleep :: hand system is th r de or ur yo :: knee system % 10 The Jstim 1000 is a proprietary electrotherapy system that works in tandem with soft infrared heat fabric, and compression therapy wraps to deliver targeted treatments to the afflicted joint. d anive ce re introducing the new jstim 1000 arthritis therapy sleep system. a break through in the treatment of osteoarthritis and rheumatoid arthritis. W BY GREG THOMPSON e hu m a n s w i l l never avoid mistakes, and the pop culture vernacular has expanded to accommodate our myriad blunders with terms such as “epic fail” and “face palm.” Admitting the error is often the first step toward learning, and it is in that spirit that education becomes most powerful. If you talk to a consultant long enough, you realize quickly that there are no “mistakes” in the land of corporate speak, only “learning opportunities.” By the same token, there are no “problems,” only “challenges.” HME owners toiling in the school of hard knocks know better. Mistakes happen, and they can be costly. Cindy Ciardo did not anticipate a five-year headache when a local hospital approached her about opening a women’s health specialty shop. After all, as CEO of Milwaukee-based Knueppel HealthCare Services, Ciardo knew how to run a business—and her reputation for outstanding women’s health services was well earned. A shop in one of the hospital’s outpatient clinics seemed like a great idea. Women’s services performed onsite at the clinic would surely add up to a good referral stream, and only two people would be needed to staff the store. What could possibly go wrong? Ciardo signed a five-year lease and began coordinating marketing efforts with the hospital system. “It started out beautifully,” says Ciardo, who also serves as director of vendor relations for Essentially Women, a group purchasing organization. “However, before the first year came to a close, the hospital system discontinued the women’s health specialty programs at that location. So there we were, in a location I did not need, with no easy referral base.” There wasn’t enough room to expand product offerings, and decor was extremely feminine. “For five years, no matter how hard we tried, we could not get that location in the black,” laments Ciardo. “We celebrated the end of that lease. My colossal mistake was not anticipating the sudden loss of referrals and preparing for that contingency by adding language to the lease that would have allowed my company to get out of the lease should something like that happen.” Advises Ciardo, “Always think of the worst-case scenario and prepare—no matter how good the prospects.” Opening a new store with a familiar product line proved perilous for Ciardo, but Black Bear Medical’s Jim Greatorex found that carrying a new product within the walls of an existing shop can also have its pitfalls. The Maine-based provider decided to add uniforms to his retail mix, a move he viewed as a “can’t miss” opportunity. The year was 1997, and Greatorex purchased an inventory of medical uniforms and scrubs to go under the same roof in his attractive and large Portland flagship store. (The company has additional locations in Bangor, Maine, and Greenland, N.H.) “I knew many others had been successful adding this line, and we thought it would be a great mix,” says Greatorex, a past president of the New England t s e g g i B take s i M ash flow’ c e iv it s o s is p ‘Happines 20 | MAY 2011 | www.homecaremag.com Have a Plan B Make sure new product lines are a “Always think good fit of the worst-case “We found that scenario and we just weren’t prepare—no good at selling matter how good clothes.” the prospects.” —Cindy Ciardo Knueppel HealthCare Services —Jim Greatorex Black Bear Medical The Lessons Check out outsourcing Don’t risk unhappy customers “You don’t have to labor in a vacuum. Leave your non-core business to the professionals and outsource everything that takes your eye off of the objective.” “Stay with the good manufacturers that provide good equipment and stand behind it. Price is not everything.” —Helen Kent Progressive Medical —Peter Czapla Quality Home Healthcare Explore alternatives “The overall caliber of people who e-mailed their resume from Monster was better than the newspaper respondents who faxed their resume.” Put the right people in the right jobs “The biggest mistake is not finding the right individual to establish internal controls.” —Les DeFelice DeFeliceCare —Alicia Correa Bexar Care Home Medical They Learned !@&# Medical Equipment Dealers Association. “We were especially enthusiastic that it would add to our three favorite kinds of business—cash, check and credit card.” The most popular uniform shop in town had undergone a management change, and rumblings of unhappy customers only fueled Greatorex’s enthusiasm. Unfortunately, two other uniform shops opened within three months of Black Bear’s big addition. The other more pressing problem was an unanticipated trend in shopping habits. “We found that uniform shoppers preferred not to shop at a place that was also loaded with DME and its accompanying madness of different transactions happening all at once,” says Greatorex. “We also found that we just weren’t good at selling clothes.” Black Bear’s hands-on, highly assistive style did not fly when sell- ing garments. As long as customers knew where the changing room was, they generally wanted to be left alone. “It came to a head when one lady tried on a scrub that had a cute animated pig in medical gear as its design,” says Greatorex with a chuckle. “Never tell a woman she looks good in a pig. “In the end, we had to get rid of $20K worth of merchandise and fixtures for about 30 cents on the dollar by selling to a friendly competitor. We moved on to other product categories that better matched our style.” Keep Your Eyes on the Prize Helen A. Kent, RRT, CEO of Progressive Medical, Carlsbad, Calif., admits to her share of mistakes, but she says the biggest was keeping accounts receivable in-house Mistakes happen, and they can be costly. for too long. With all of the changes in coding, policy, regulations and reimbursement, she ultimately found it impossible to run the business while maintaining outstanding service. One attempt to outsource ended poorly, so back inhouse it went. Things improved slightly, but days sales outstanding (DSO) kept rising. When Kent requested more information www.homecaremag.com | MAY 2011 | 21 from her billing staff, she did not get the answers she needed. “Everyone who runs a small business knows that being able to collect on your accounts is the lifeblood of the business,” says Kent. “It’s great to sell a product, but if you cannot collect, all you have done is give away a piece of equipment while you are stuck with an invoice from the seller.” Kent called around in an attempt to find a billing service that could adequately handle accounts receivable, while also working seamlessly with a business management system, and she ultimately found one. “If it had not been for that call … I would probably be following the same forlorn road, or I would be out of business with all of the cuts in the HME industry,” says Kent. Outsourcing AR functions also allowed her to eliminate positions for two billing clerks and decrease her payroll. DSO now hovers around 85 to 87, what Kent believes is a good number considering that she bills a large number of E0471 (RADs) and E0601 (CPAP) products—among the most difficult codes to get paid. “You don’t have to labor in a vacuum,” Kent points out. “Leave your non-core business to the professionals and outsource everything that takes your eye off of the objective. You will have more time to devote to growing and running your business.” Rob Brant, general manager of City Medical Services, North Miami Beach, Fla., got fed up with paying 6 percent a year to All About according to health care attorney Clay Stribling of HC Comply, amarillo, Texas, one of providers’ most common mistakes today is not empowering company compliance officers. With the pace and ferocity of Medicare audits on the increase, the best way to get prepared is to build what Stribling calls the “triangle of compliance” through internal audits that identify any vulnerabilities, taking corrective action to fix them and training staff to make sure the fixes hold. “your compliance officer needs to be empowered,” says Stribling, because it takes both time and money to develop an internal audit program. How effective that program is in helping you fend off audits probably depends on “how many hats” your compliance officer/internal audit coordinator wears, he notes. If that employee also happens to be your company’s billing manager and safety coordinator, that doesn’t leave much time to focus on internal auditing. HomeCare: What is the most common compliance mistake that you see in your role as a consultant? Stribling: The largest mistake is failing to provide adequate resources to your compliance function. your compliance function requires time and money to be effective. Way too many companies appoint an employee as the compliance officer and then say compliance is this person’s second priority | May 2011 Cash Flow Is King Mistakes that slow down cash flow are particularly problematic, and in today’s economic climate—which includes competitive bidding—those errors can be downright calamitous. Tom Ryan, president and CEO of Homecare Concepts, Farmingdale, N.Y., once forgot that “happiness is positive cash flow,” and the lapse haunted him for a long time. In the early days, Ryan explains that HME providers had more long-term capital leases to help during periods of growth. As businesses matured, they could pay more toward the lease as cash flow improved. while their other job is the first priority. This leaves the employee with too little time to devote to chart auditing, training and compliance review. Priorities 22 a billing agency, so he brought all billing functions in-house. The effort led to a large expense for software, plus a new employee at $40,000 a year. “The new billing software was problematic,” says Brant. “After we finally got the billing under control, the billing manager’s husband got a job out of state and she left. I ended up coming back to my outside billing company on my hands and knees begging them to take me back. The owner explained that his staff of 60 would never call in sick, take a vacation or move.” (After this article was prepared, Brant decided to close his company as a result of Round 1 competitive bidding. For more on his situation, read “PAOC Speakers Give CMS Another View of Competitive Bidding” at www.HomeCareMag.com.) | HomeCare: Does devoting more resources inevitably increase costs? Stribling: Most often, a company is already using a relatively high-cost employee to tend to compliance, someone such as a billing manager or HR manager. Hire a parttime employee that’s inexpensive to do a small portion of that person’s job, perhaps to serve as a chart-auditing assistant. Or bring some assistance to other functions that don’t require a premium employee. That should free up some time to devote more attention to compliance. I understand there are financial restrictions, and you can’t just wave a magic wand and have enough money to spend on this process. By being creative, reassigning some employees and moving other duties to less expensive employees, I think you can—at a pretty small cost—allocate resources the right way. For a relatively small cost, you can improve the efficiency of your employee on the compliance function by getting him the right training. Send him to a seminar on health care compliance. There are some great organizations such as the Health Care Compliance association. By sending your employee, time spent on the learning curve goes down. HomeCare: Should home care providers outsource for compliance services? www.homecaremag.com Stribling: It depends on the organization. Ultimately, you don’t want to depend on an outside service long-term. For a lot of companies, it’s a great one-time solution to bring in somebody to help the compliance officer get up to speed, and help him or her understand a little more about day-to-day job functions. What you’re really looking for is a resource to make that compliance person better, not to service your compliance function forever. The ultimate goal is to bring that in-house, and make your in-house personnel as effective and professional as possible. HomeCare: How would you characterize the current climate of CMS audits? Stribling: In a word—hostile. auditors start with a heavy bias toward denial of claims, particularly the RaC auditors who have a financial incentive to deny claims. I don’t think that any of the audit groups are any more prone to payment of claims, and you can look at the claims denial rates in different regions and see. Denial rates in some regions are 85 to 90 percent on some products. On the back end, a huge percentage of those denied claims are getting overturned on appeal. From an initial claims standpoint, it’s a hostile environment for suppliers. Effective May 16, HC Comply will become a new division of The van Halem Group as Clay Stribling departs to become president and CEO of the Amarillo Area Foundation, a reigonal charitable organization. “My reluctance to pay those leases and rates again, and service calls,” says Czapla. “More importantly, we had custhe decision I made to avoid them, was one of my biggest tomers that were not happy about their wheelchairs breaking business mistakes,” confesses Ryan, a past chairman of AA- continuously. We would continue to repair it, and that was a Homecare. “I decided to be aggressive in the OGPE (oxygen big cost to the company.” generating portable equipment) market, replacing 80 percent With reimbursement decreasing every couple of years, Czapla of my oxygen patients to the new high-capital, low-service admits that he still gets the urge to buy low-cost goods, thinktechnology, while at the same time having all new starts go ing that this time things may be different. to this newer technology. “I wanted to be known as the new technology company. I believed this would become a differentiatthat we operate ing point, and my market share efficiently and minimize mistakes, but we can’t be would increase accordingly.” Market share did increase, but paralyzed by the fear of making one of those mistakes.” not as much as anticipated. Ryan’s —Paul Ondrusek The MED Group aggressiveness toward the conversions, combined with the decision to take 0 percent financing 12-month leases, ultimately ran him into trouble. “There were some Christmas specials a few months ago that These days, Ryan has a simple tool that generates a monthly I bought only to find out once again that the quality was not cash flow projection spreadsheet. If he had had this technology there,” says Czapla. “Stay with the good manufacturers that sooner, he thinks he might have averted a lot of headaches. provide good equipment and stand behind it. Price is not ev“This tool would have given me clear warning that the debt erything. At the end of the day, you are going to end up with service coverage on all these short-term leases would soon be an unhappy customer, and that is something that none of us choking my ability to pay off receivables, and I would have can afford.” seen that my accounts payable would grow, leading to cash Fortunately, bargain-hunting can sometimes pay off with flow deficits,” says Ryan. lower prices and even better results. When it comes to post“The difference in a longer-term lease with terms would have ing jobs, Alicia Correa, RN, BSN, MBA, decided to give Monbeen clear as viewed on my cash flow projector, because the ster.com a try instead of using the local newspaper. Monster savings in interest was insignificant, and the drain on cash charged less, ran the ad longer and yielded more qualified flow was very significant. I could have used this calculator to candidates. warn me to slow down the aggressive conversion and increase As president and CEO of Bexar Care Home Medical in San the terms.” Antonio, Correa admits to a few hasty hires in the past while Through means including personal cash infusion, loans and trying to get a warm body in the door. Using the local paper, retro vendor leases, Ryan is again seeing positive cash flow. “My she once hired a woman who simply could not grasp how to cash flow projector is now projected out for at least four to five deal with customers on the phone. “It turned into a disaster,” months ahead, and updated monthly for the actual cash flow says Correa. “She would not ask basic things such as name, deficit or surplus,” he says. “I am happy to say that happiness number or even what hospital. I had to remind her to get deis positive cash flow once again.” tails and sound alive on the phone.” Ryan may have moved too vigorously in his conversion to It could be that Monster.com users are a bit more tech-savvy OGPE, but mistakes can also result from failing to act. Paul than newspaper browsers, but whatever the reason, Correa Ondrusek, western regional manager for member services orga- says, she will stick with Monster. “It was only $100, and Monster nization The MED Group, Lubbock, Texas, has seen providers ran the ad for two weeks,” says Correa. “In the local paper, I miss opportunities because they failed to be proactive. was paying $300 for one Sunday. The overall caliber of people “It is more important than ever that we operate efficiently who emailed their resume from Monster was better than the and minimize mistakes, but we can’t be paralyzed by the fear newspaper respondents who faxed their resume.” of making one of those mistakes,” says Ondrusek. “That’s why With labor such a large expense in any business, bringing networking with other successful business owners who are in less-than-ideal employees can lead to long-term miseries. willing to share their experience and knowledge is becoming Especially in the industry’s current environment, combining more valuable every day.” the wrong person with a culture that is focused on cost reduction can make things worse. Good Bargains and Bad Bargains “The biggest mistake is not finding the right individual to Peter Czapla, owner of Wetumpka, Ala.-based Quality Home establish internal controls,” says Les DeFelice, CEO of DeFeHealthcare, can’t resist a good bargain. After 20 years in the liceCare in Wheeling, W.V. “Without a strong person in that home care world, however, he knows that a “good bargain” role, it is impossible to establish a culture of cost reduction can often be a contradiction in terms. while growing your company. I started in 1995, and it wasn’t Lured by discount specials, Czapla has received his share of really until 2007 that I had strength in that area. damaged, low-quality goods. “All the money I thought I was “It doesn’t matter what your revenues are,” DeFelice reminds, saving by buying the special discount was lost in repairs and “it is how much your profit is.” “It is more important than ever www.homecaremag.com | May 2011 | 23 Market Analysis Bariatrics is a big growth market, but you’ve got to know—and show—the products One Size Doesn’t Fit All A challenge for the bariatric market is to define what the term means. Doctors may define an obese patient as one with a body mass Index (BMI) of 30 or more, while Medicare may define a bariatric patient based on weight. Neither definition accounts for body types and other variables. HME providers may also be discouraged by the capital outlay required to provide bariatric products, says Phil Cunningham, business manager for home care beds, Invacare. The equipment is different—and more expensive—than standard home care products. However, Invacare and other manufacturers now offer financing plans that can help to spread out those costs and keep them in line with monthly receivables. “I would say the market out there is significant enough that in almost any DME area, there’s a bariatrics market, but the challenge is to find referral sources and speak to them specifically about bariatrics,” says Cunningham. He encourages providers to bring up the subject with referral sources: “Tell me about your bariatrics, tell me about your obese patients.” According to Cunningham, the sector remains largely untapped. “There are huge pockets in the country where they don’t have access,” he says. But it’s a not a market for everyone. “I cannot stress enough the sensitivity and compassion [needed] when working in bariatrics as well as keeping yourself educated on the products available and the needs of the patient,” says Roberta Jacobs, national sales manager for bariatric product maker Gendron. Understand Consumer Needs, Put Quality First The market for bariatric HME products is growing right along with the country’s waistline. More than a third of U.S. adults are now considered obese, a number that has been trending up for two decades. That’s something Elaine Latham, a bariatrics specialist at Electropedic, sees first-hand. “I have been called ‘an angel’ because I listen to people and help them,” says 24 | MAY 2011 | www.homecaremag.com Invacare’s TDX SI-HD power wheelchair has a 450-lb. weight capacity. BY LARRY ANDERSON COD COD E E CODE CODE COD E COD E CODE E COD COD E E CODE E ½ Plate � Microwave, grill and stir-fry fresh or frozen veggies � Load up salads and pizza with spinach, tomatoes and onions � Store pre-cut veggies in a clear veggie bowl at the front of the fridge � Enjoy two brightly colored veggies with lunch and dinner Fill ¼ Plate trout and halibut for healthy Omega 3s � Enjoy a meatless meal with black bean tacos, stir-fried tofu or veggie burgers � Buy red meat labeled round, sirloin or tenderloin � Spice up skinless chicken FIBER-RICH CARBS Fill ¼ Plate � Try new whole grains like quinoa (keen-wah) or barley � Buy breads with 3 or more grams of fiber � Mix whole-wheat pasta with regular pasta � Choose brown rice over white and fried rice Smart Plate LEAN PROTEIN � Eat fish twice a week — try wild salmon, rainbow Servings inch Smar t 1. 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Electropedic has two stores in California and one in Phoenix, with about 60 percent of its bariatric business online. Latham has a lot experience providing various bariatric products, from lifts to scooters to beds, which has given her a good view of the market. She emphasizes the benefits of listening to bariatric patients to figure out the products that can help them at home. Too often, she laments, providers tend to favor a limited number of beds or other equipment that may not work for these patients. “The bed is the most important thing,” Latham says. “When you bring someone home from a nursing home, the first things you need are a bed and a proper mattress.” She warns against the pitfalls of price sensitivity related to bariatric beds. Buying a less expensive model of lesser quality is unlikely to meet the patient’s needs, she says. Latham also emphasizes the importance of matching the right mattress to the person. “It’s very specialized,” she says. The same concerns extend to the assortment of available bariatric products, such as shower chairs and toilet products. “The whole industry has bariatric equipment,” says Latham. “The manufacturers are out there. “I try to help people with different kinds of options,” she says. Latham knows all too well the challenges of being homebound. Her late husband suffered through a long illness and was confined to a bed. “The last year was not easy, so I can sympathize,” she says. “I understand what people go through.” ConvaQuip’s Model 1000F freestanding trapeze folds up and has wheels so it can be moved from room to room. fornia’s MediCal (Medicaid) program and convinced authorities to pay for the larger bed—a successful outcome that happens all too seldom. Appealing to Medicare is less successful. “I can’t change it,” says Latham. “Unfortunately, a lot of people who make the rules have not been in this position and don’t know what they are dealing with.” Latham remembers another patient who was unable to get out of bed, but Medicare didn’t cover the electric lift she needed. That means some bariatric patients whose caregivers may be frail or elderly, or those unable to handle the patient safely even with the help of a manual lift, are stuck, she says. Choosing beds based solely on weight also presents other problems, says Latham. “People lie about their weight, so if someone says they weigh 350 pounds, I would never give them anything close to 350-lb. weight capacity.” Latham also notes that certain medications can cause rapid weight gain that could make a prescribed bed inadequate within weeks. Latham’s bottom line on Medicare? “There are too many rules and regulations,” the frustrated provider states. Make the Right Choices Drive Medical also recognizes the challenge of identifying what is considered “bariatric,” according to Ed Link, vice president of marketing. The manufacturer offers a full line of bariatric products targeted to bath safety, mobility, beds, patient room pressure prevention and powered mobilthat are working with ity. The company recently introduced a 22-in.-wide bariatric patients are often not aware of the transport chair that can accommodate 450 pounds and weighs only 33 pounds. different product options available to them.” Drive includes a BMI index in its catalog to help deter—Cynthia Counts, GF Health Products mine the extent of obesity, but Link recommends better training for staff to identify specific bariatric needs. “If you are providing equipment for a specific patient to The government’s rules need to change related to bariatrics, use at home, many measures should be taken to ensure you contends Latham, but she doesn’t expect they will. “They go are getting the proper equipment,” adds Jacobs of Gendron. by weight [of the patient], not by the needs of the patient,” “Wheelchairs are not one-size-fits-all, and a patient should she notes. be measured for their chair. The same for the bed, dependFor example, a patient must weigh at least 351 ing on the patient’s size and ability. The bed pounds to qualify for a 42-in. bed, and more than should be selected that best meets the needs 600 pounds to quality for a 60-in. bed, Latham and functionality of the patient. This may explains. She recalls a 37-year-old patient require a width/length-adjustable bed, a lowwho weighed 557 pounds and had been height bed or both.” in a flat bed for five years. “They wanted When selecting a bed for a specific patient, Jacobs to put her in a 42-in. bed, so I had the says, it is important to look at multiple choices “to nurse measure her girth. This woman ensure the patient is getting the proper product.” is 51 inches and you want me to put Gendron’s bariatric beds can meet the needs of paher in a 42-in. bed?” asked Latham. tients up to 1,000 pounds. The company’s Model In that case, she appealed to Cali3807 is an ultra-low bed designed to meet the needs of the patient when fall prevention is imDrive Medical’s ATC22 bariatric transport portant. With a weight capacity of 500 pounds, the chair weigns 33 lbs. but can support 450 lbs. three-function electric bed can be width-expanded up to 48 in. The company also offers wheelchairs, “Many places 26 | MAY 2011 | www.homecaremag.com Your Freight. Our Support. Your Solution. With a nationwide network of major carriers, multiple distribution centers, and over $6 million of ramp inventory, EZ-ACCESS is the manufacturer that can maximize your business opportunity. With faster delivery times and lower inventory costs... We’re here to help. Delivery Time • Same-day shipping • 2-3 day delivery anywhere in the US Inventory • No minimum size required • We will drop ship directly to your customer Cost • Multiple carrier options • East Coast & West Coast distribution centers Maximize your freight savings – Call today at 1.800.451.1903 www.ezaccess.com EZ-ACCESS is a registered trademark of HPi. Text and images © 2007-2011 Homecare Products, Inc. All rights reserved. walkers, recliners and bath safety products, and last fall, moved its assembly operations—for the second time in five years—in response to the growth in its bariatric business. Jacobs adds that HME providers should be educated on the equipment that is available, be aware of the geographic market they serve and create relationships with referral sources for bariatric products. “Value-added service is also a key factor in establishing a solid bariatric business,” she says. Let Customers Know You’ve Got the Products Because bariatric equipment is not a high sales category, providers tend not to stock these items, says Brad Goodman, vice president of ConvaQuip. But he also believes that even “carrying one or two items in the better-selling categories can enable consumers to get a hands-on look at the product, which would help sales.” Gendron’s bariatric low bed is designed to meet the needs of patients when fall prevention is important. that are working with bariatric patients are often not aware of the different product options available to them,” she says. She, also, recommends showcasing bariatric to promote and options on the sales floor. “Some retailers show the position yourself as a provider of bariatric standard items and are unaware that they could be missing opportunities for someone to see an item equipment. Get that message out now.” that could benefit themselves or someone they know,” —Brad Goodman, ConvaQuip Counts suggests. Last month, Graham-Field introduced its Lumex Bariatric Folding Commode to accommodate the growing barIn ConvaQuip’s wide-ranging line of bariatric products, iatric population. The new product offers both a greater weight including a single-point cane to a fully electric bed, products capacity and more seating surface to provide the same level have weight capacities going from 350 to 1,000 pounds. One of user comfort as a standard commode, and is easier to store, of the company’s products is a freestanding trapeze with a transport and deliver to the patient, the company says. 1,000-lb. capacity that folds up and has wheels so it can be moved from room to room. The Time Is Right Goodman contends the bariatric market is about more than Invacare’s Cunningham sees some utility for bariatrics-dijust providing equipment. Bariatric equipment can aid safety rected equipment among non-bariatric patients. He gives the by preventing injury to a patient or caregiver. He recommends example of a patient whose spastic body movements, including that providers’ websites include a specific “bariatric” category. tensing up and pushing on the footboard, were destructive to They should also educate employees about the manufactures his standard bed. The patient was put in a mid-level, stronger and distributors that deal in bariatric products, and the types bariatric bed, which was more satisfactory. of products that are available, he says. “Many times we get a Cunningham says Invacare is seeing significant growth in call from a company looking for an item and wondering if they wide-bed sales (39-42 in.) in the long-term care market, largely could set up an account, only to find their company already for safety reasons among patients likely to roll out of a 36-in. has an account,” Goodman says. bed. While he notes that home care trends tend to follow those Cynthia Counts, director of homecare sales and marketing in long-term care, a challenge is that Medicare will not pay for GF Health Products, agrees. “The bariatric market is some- enough to supply a wider bed, and the difference often makes times overshadowed by the standard products out there,” the approach cost-prohibitive. Counts says. “While the volume for DME products is largIn addition to beds, Invacare’s bariatric line includes er with the standard options, some providers sleep surfaces, wheelchairs, walking, bathing and are doing very well with the category patient transfer aids and is targeted to patients because they understand the need for from 350 to 750 pounds. it, which increases when consumers One of the company’s key bariatric prodare informed of their options.” ucts is its BAR750 bed with a split frame that Counts says HME providers can is expandable for various height and weight increase business in the category ranges. The bed is used both in long-term care by researching their local areas and facilities and for home care, so a patient going targeting rehab centers. “Many places home from a facility can use the same bed he or she is familiar with. Jeff Hollander, sales and marketing director Graham-Field’s Lumex Bariatric Folding Commode folds to less than 7 in. for of scooter maker Ranger All-Season, says his storage and has a 650-lb. weight capacity. company, too, has “seen an upswing” in provider interest in bariatric products. The company “It is a good time 28 | MAY 2011 | www.homecaremag.com offers several bariatric models, including the Solo HD in three- and four-wheel models with a weight capacity of 450 pounds, and the Solo XT550, a fourwheel scooter with a weight capacity of 550 pounds. According to Hollander, he’s seeing an increasing number of providers who are putting higher weight-capacity scooters on the showroom floor so that bariatric clients can test drive an appropriate model on the spot. Displaying bariatric devices “increases the probability that a sale can be made,” Hollander says, adding that too many providers are overlooking an important source of new revenue by not providing bariatric products for the client base in their local areas. He points out, however, that customer service reps should be knowledgeable about bariatric products from various manufacturers and about each product’s history of safety, reliability and longevity. (His company, he says, has begun to catalog the number of Ranger scooters that have demonstrated exceptional longevity, including some scooters that are 19 and 20 years old and still functioning.) Hollander says providers should become known as the bariatric experts in their locale and communicate to consumers that expert, caring hands are waiting to serve them, that they have working models on the showroom floor and that friendly representatives can fully explain the benefits and use of the products. ConvaQuip’s Goodman thinks providers should consider becoming a “one- stop shop” for bariatric items. “Typically, if the end-user needs one piece of equipment, it’s likely they need other items as well,” he points out. With more demand for bariatric products among t he burgeoning baby boomer population, he advises, “It is a good time to promote and position yourself as a provider of bariatric equipment. Get that message out now. State that in all of your literature and on your websites.” Ranger All-Season’s Solo XT-550 accommodates riders up to 550 pounds. We’re your support while you are focused on the accreditation goal. Your HQAA coach is your crew chief. EXPERTS INTERVIEWED ■ Cynthia Counts, director of homecare sales and marketing, GF Health Products, Atlanta ■ Phil Cunningham, business manager for home care beds, Invacare Corp., Elyria, Ohio ■ Brad Goodman, vice president, ConvaQuip, Abilene, Texas ■ Jeff Hollander, sales and marketing director, Ranger All-Season, George, Iowa ■ Roberta Jacobs, national sales manager, Gendron Inc., Bryan, Ohio ■ Elaine Latham, bariatrics specialist, Electropedic, Burbank, Calif. ■ Ed Link, vice president of marketing, Drive Medical Design and Manufacturing, Port Washington, N.Y. From the time you sign up, through your standards documentation. Beyond the survey to post-accreditation. Your crew chief will help you not only finish the process, but finish strong — with high quality standards. To get started, visit www.HQAA.org/coach or call 866.909.4722. Become a Quality Champion. www.homecaremag.com | MAY 2011 | 29 Product( FOCUS ) Seating & Positioning Invacare Matrx Personal Back 10 ■ provides comfort, postural support and spinal alignment ■ available in standard and bariatric widths; back heights of 14 or 16 in. ■ 250-lb. standard weight capacity; bariatric 500 lbs. www.invacare.com Blue Chip Medical Products Chair-Air 9700CAF ■ four individual bladders alternate to provide a pressure redistribution seating surface; system includes alternating pump ■ molded design, with slight abductor pommel, stabilizes the hips and keeps the patient in proper mid-line alignment ■ Aquila Corp. Airpulse PK ■ powered, alternating pressure, wheelchair cushion system ■ alternate air cells inflate/deflate automatically to desired firmness on adjustable cycle time; action relieves pressure and stimulates circulation to treat and prevent pressure sores ■ custom-made to address user’s specific physical characteristics and health status zippered non-skid stretch-knit cover is antimicrobial and fire-retardant. www.bluechipmedical.com Karman Healthcare www.aquilacorp.com Ergo Fit ■ 2 in. contoured memory foam cushion with non-slip bottom ■ hand-washable ■ black; available in 16 x 17 in., 18 x 17 in. or 20 x 17 in.; fire retardant Stealth Products Ultra Lightweight Pediatric Back ■ adjustable up to 2 in. in width and height; single lightweight center point of contact or two point contact ■ mounting with use of lightweight rigidizer bar ■ adjustable lateral supports www.karmanhealthcare.com www.stealthproducts.com COMING UP IN Product Respiratory Products 30 | MAY 2011 | www.homecaremag.com Complete Medical Supplies Supracor Stimulite Tension adjustable Back Gel/Foam Wheelchair Cushion with Fleece Top n gel/foam construction protects skin while offering weight positioning n fleece top for comfort; cream colored fleece top, bottom half of cushion is navy blue n available in 16 x 18 x 3.5 in. or 16 x 22 x 3.5 in.; weight capacity 250 lbs. www.completemedical.com n ventilated honeycomb allows air to flow both horizontally and vertically to prevent heat build-up and humidity; equalizes pressure for comfort and stability n available for folding and rigid wheelchairs; adjustable Velcro straps ensure a custom fit and can accommodate for kyphosis or posterior pelvic tilt n honeycomb and removable, breathable cover are machine washable; available in widths from 14 to 24 in. www.supracor.com Star Cushion Products 5” Starlock Cushion n 5-in. cell height n tall cell height allows for deeper immersion and ensures dispersion of weight bearing throughout the entire surface area n enables flexibility to address asymmetry and other complicated patient issues www.starcushion.com Varilite Meridian Cushion n two independently adjustable, air-Foam floatation chambers create pressure distribution and allow for independent positioning of pelvis and thighs n dual chambers work together to correct sacral sitting by creating a pre-ischial ridge, preventing the ITs from sliding forward into a posterior pelvic tilt n removable, washable cover available in mesh or incontinence material; combine with a contoured Wave base for added positioning stability; sizes range from 12 x 14 in. to 24 x 20 in. www.varilite.com For ONE User Station Get YOUR personalized offer! 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Carex Health Brands Lightweight Foam Wheelchair Cushion ■ comfortable, lightweight foam designed for people who sit for long periods of time ■ easily transportable; for transport chair or wheelchair ■ machine washable cover Hudson Medical Products Pressure-Eez Lite ■ 2- or 3-in. thick gel foam cushion; embedded with a channel gel bladder for pressure distribution and weight equalization to prevent bottoming out ■ foam frame sidewalls provide support ■ widths of 16 to 22 in. and depths of 16 to 18 in.; available in four therapeutic covers www.carex.com www.hudsonindustries.com Sunrise Medical JAY Zip Cushion ■ skin protection and positioning cushion designed for pediatric use; available sizes range from 8 x 8 in. to 16 x 18 in. ■ dual layered contoured foam base and soft, stretchable outer cover; reticulated foam in the outer cover promotes air movement to prevent heat and moisture build-up ■ two machine washable outer covers included; silver impregnated X-static stretch fabric in outer cover naturally inhibits bacterial growth www.sunrisemedical.com Quantum Rehab Synergy Shape Deep Contour Back ■ features fully adjustable, 7-in. (height) x 6-in. (depth) gel-covered thoracic lateral supports and dual layer foam construction with a viscoelastic foam top layer for pressure management and comfort ■ back has angle adjustment of 57 to -33 degrees and 2-in. depth adjustment, which can occur with the user in the chair ■ two-point, quick-release or four-point bolt-on mounting hardware www.quantumrehab.com Permobil Drive Medical Corpus 3G ■ ergonomic design that follows the contour of the body ■ DuraCore tilt offers up to 50 degrees of tilt; reclines 175 degrees ■ depth, width, height and angle of multiple seat components can be adjusted or customized Wenzelite Rehab First Class Chair ■ designed to assure good feet-on-the-floor posture; provides multiple adjustments and options to meet needs as child grows ■ easy adjustments simplify use; pelvic belt and height-adjustable armrests ■ adjustable seat with a tilt of up to 15 degrees; upholstered and covered in washable vinyl www.permobil.com www.drivemedical.com 34 | MAY 2011 | www.homecaremag.com INTRODUCING NEW TO THE U.S.A. 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As the target of relentless reimbursement reductions throughout the years, oxygen providers suffered yet another blow in the form of a Government Accountability Office report issued in February. CMS is paying too much for oxygen,” says Bob Hoffman, RRT, director of VGM’s Nationwide Respiratory, Waterloo, Iowa. “More importantly, at the end of the report, they did say that CMS should restructure Hoffman Medicare’s home oxygen payment methodology to establish more accurate rates for all the different types of oxygen.” Medicare payment for concentrators, for example, encompasses the machine, supplies and oxygen refills. “That should not be the case,” argues Hoffman. “As a result, they are paying less than they should for the portables.” At the same time, some clinicians are pushing for better prescriptions and more monitoring to make certain that oxygen therapy—and equipment—is doing its job for the patient. As usual, providers are left wondering how they are going to provide service and survive in today’s market. As to the Success question of whether Factor CMS is subtly pushing providers toPortable Oxygen ward one modality or the At its core, the 114-page report contained many of the same conclusions as in the past but with a hint of a silver lining lurking beneath the black cloud. “In the report, the GAO did come flat out and say that Oxygen: Not for the Faint of Heart Just check the crystal ball and place your bets BY GREG THOMPSON 36 | MAY 2011 | www.homecaremag.com The Evolution of Oxygen Conservation TM s :PTWSLW\ZOI\[[VUKLZPNU s (\[VTH[PJZO\[VMM s :H]PUNZYH[PVVM! s <UPMVYTW\SZLYLNHYKSLZZVM IYLH[OYH[L s :LUZPUNHUKKLSP]LY` [LJOUVSVN`HZZ\YLZWYVWLY ZH[\YH[PVU 0U[YVK\JPUN[OL5,>¸,=63<;065 ¹VMV_`NLUJVUZLY]H[PVU MLH[\YPUNHZTHSSLYHUKSPNO[LYLSLJ[YVUPJJVUZLY]LY^P[OH TM minimum of two years battery life!* ;OL,=63<;065 VMMLYZHSS[OLNYLH[WLYMVYTHUJLMLH[\YLZ[OH[OHZTHKL*/(+;OLYHWL\[PJZ[OL SLHKLYPULSLJ[YVUPJV_`NLUJVUZLY]H[PVU>P[OHZLUZP[P]L[YPNNLYPUNTLJOHUPZTMHZ[KLSP]LY`[PTL HUK\W[VÅV^ZLSLJ[PVUZ[OL,=63<;065 JHUHJJVTTVKH[LHIYVHKYHUNLVMWH[PLU[ZHUK JVUKP[PVUZ;OL,=63<;065 HSZVKLSP]LYZH\UPMVYT]VS\TLVMV_`NLU^P[OLHJOW\SZLYHUNPUN MYVTIYLH[OZWLYTPU\[L TM TM TM Join the new EVOLUTION of oxygen conservation and learn how we can help you save time and money while meeting the clinical needs of your patients. TM Your O2 Conserving Experts 1-800-423-8870 ext. 300 ,=63<;065PZH[YHKLTHYRVM*/(+*/(+PZHYLNPZ[LYLK[YHKLTHYRVM0UV]V0UJ (]LYHNLKHPS`\ZHNLVMOV\YZWLYKH` /VYZLZOVL+YP]L:V\[O:\P[L5HWSLZ-3 ^ ^ ^ JO HK[O LYH WL \[PJ ZJVT -( ? ;VSS - YL L 800 .4 23.8 8 70 “I don’t think CMS really cares as far as one modality or the other. They are just looking for ways to cut the budget.” associated with the provision of ambulatory oxygen systems, and the services associated with home oxygen therapy.” Lewarski believes that any future proposed payment reduction and/or change in payment methodology will naturally point up the viability of non-delivery systems as the most cost-effective option for ambulatory oxygen patients. “This only gets exaggerated with additional payment reductions,” he says. Money Matters Portable oxygen concentrators are still a relative newcomer to the market, and acquisition costs can be a barrier for some providers. As always, the definition of pricey depends on many factors. “You can’t say POCs are too expensive for everyone,” says Hoffman. “It depends on the size of the company. POCs take away the delivery costs. That certainly is efficient for some, but not the answer for everybody.” Cramer Decker’s 02 other, Hoffman doesn’t believe it. “I don’t think CMS really Hoffman calls transfill systems the Sidekick is a retail product cares as far as one modality or the other,” he says. “They are future of the market. “Home transfill that is an upgrade from the just looking for ways to cut the budget.” systems take away all the costs astraditional oxygen cart. Fundamental concerns with the GAO report include sociated with delivery,” he says. “In specific questions of methodology. Ron Richard, vice addition, manufacturers are coming up with smaller tanks president and general manager, respiratory, Chart with conserving devices to use in conjunction with transfillSeQual Technologies (a division of Caire), San Diego, ing. These conservers extend the time that the tank can be Richard points out that the eight private insurers the GAO inutilized away from the home.” terviewed for its report used payment methodologies similar Kelly Riley, CRT, RCP, agrees that POCs and transfi ll systo Medicare’s, but seven did not use a rental cap. tems will reign—a decade from now. “As the new technology According to the report, if Medicare had used the payment evolves,” says Riley, director of Lubbock, Texas-based The MED rates of the lowest-paying private insurer, it could have saved Group’s National Respiratory Network, “the benefits of portable about $670 million of the estimated $2.15 billion it spent on oxygen will enable ambulating patients to lead a better quality home oxygen in 2009. But Richard explains, “If the cap is of life, with better outcomes for all involved.” taken out of the equation, one has to assume that they are not On the persistent question of upfront costs, Riley says her projecting a ‘longevity’ variable, just per-year costs. In other organization has crunched the numbers and POCs come out words, it does not seem they are accounting for a particular favorably. “We found that for patients who need portability, the beneficiary’s length of usage—and suppliers’ billing—to cal- break-even is at about half of the total cost of the traditional culate costs/savings.” concentrator-tank delivery model,” she says. Adds Joe Lewarski, RRT, FAARC, vice president of Scott Decker, president of Cramer Decker Medical in Elyria, Ohio-based Invacare’s Respiratory Group, “I Santa Ana, Calif., says providers have been reluctant don’t think anyone is surprised to see another governto invest in rapidly changing POC technology that ment report that suggests oxygen payments should they still perceive as too expensive. “Other products Decker offer the same oxygen supply at much less cost,” Lewarski be further reduced.” However, he says, “The report did recognize the costs associated says Decker. “Portable oxygen cylinders have dominated the with the service component of market in the last five to seven years. With that said, POCs are home oxygen therapy, as well as up-and-coming technology, and in a few years I see them as the need to ensure access to am- a much larger feature of the market.” bulatory oxygen technolo“If one is simply comparing the acquisition cost of a See page 14 gies. In this regard, the cylinder to the cost of a POC, it looks expensive,” conreport suggests a need for cedes Lewarski. “However, the cost of providing cylinfor a look at Klingensmith oxygen payment reform der gas is heavily weighted in the recurring operational HealthCare’s to better address the costs costs associated with storage, filling, record-keeping, new patientcustomer service, warehouse staff and delivery of cylcentered DASH program for The Inogen One is smaller, lighter “and inder gas. In most cases, the recurring monthly cost of COPD patients. makes more oxygen with a longer providing cylinder gas to ambulatory oxygen patients battery life,” Inogen says. —Bob Hoffman Nationwide Respiratory 38 | MAY 2011 | www.homecaremag.com Have you logged onto HomeCareMag.com today? After you’ve read HomeCare magazine, there’s even more HME industry information waiting for you at HomeCareMag.com. Log on anytime for up-tothe-minute news, the digital edition, web polls, podcasts, HomeCare Monday archives and Online Buyers’ Guide. It’s a complete multimedia resource that no one else can match. Bookmark HomeCareMag.com as your HME daily digest today! THE OFFICIAL MAGAZINE OF MEDTRADE is significantly more expensive than the amortized monthly cost of a non-delivery system.” While non-delivery options lower gas expenditures and many other costs, patient education and service are still necessary. CMS has never understood this service component, Riley says, and despite the Riley hopeful wording in the GAO report, she believes the mentality shows little sign of changing. “Government entities simply cannot grasp the concept that oxygen is a service-driven industry,” she says. “Many of those costs are directly associated with doing business with the government. They are enhancing the message that you must diversify away from Medicare markets, because we simply cannot afford to take any more cuts, no matter what delivery model you are using.” Moving POCs into the cash-sale realm is another option that is already happening at some providers. “Baby boomers are willing to spend money on their medical care over and above what Medicare and insurance carriers will pay,” notes Hoffman. “Certainly some providers are looking at POCs as more of a retail cash item as opposed to a reimbursed item, because Medicare is not going to pay for both systems.” As is the case with other consumer products, Scott Wilkinson, executive vice president, sales and marketing, Inogen, Goleta, Calif., believes providers must review patient wants and determine which POCs Wilkinson fulfill the majority of those wants. “One of the keys to success in any market, and ours is no exception, is delighting the patient,” says Wilkinson. “Size, weight, noise level, battery life and ease of use all factor into this decision. Providers also need to look at what’s important to their business. Durability, warranty, range of patients serviced, marketing support and post-sales service should all be considered.” Competitive Bidding Not Registering Yet Inogen experienced its best revenue year in 2010, Wilkinson says, and he expects strong growth in 2011. He anchors his optimism to expansion of the overall patient market—but he tempers his enthusiasm. “Many oxygen suppliers are reluctant to make the investment in new technology products due to reimbursement uncertainty,” Wilkinson acknowledges. “It’s still unclear what will happen with Round 2 of competitive bidding. Will it be implemented similar to Round 1 in the 91 MSAs? Will it be revised to address flaws uncovered in Round 1? Will it be repealed? Many suppliers are not sure they will even stay in business.” Pr ior to compet it ive bidding, Chart SeQual’s Richard points out that stationary rates were as high as $250 to $280 per Non-delivery systems such as Invacare’s HomeFill and its Solo2 can keep oxygen providers viable, says the company’s Joe Lewarski. 40 | May 2011 | www.homecaremag.com The Eclipse 3 and the Helios are Chart SeQual’s most popular portables. month, and competitive bidding has reduced that by at least half, if not 60 to 65 percent. “Now that those rates have been established, adopt them and eliminate competitive bidding,” he states. “Utilization trends show overall beneficiary access to home oxygen has not diminished, despite reductions in payment rates and in the number of suppliers from 2001 through 2008,” he continues. “There is a world of difference between beneficiary access to home oxygen and beneficiary access to clinically appropriate home oxygen. CMS’ own numbers indicate that 85 percent of oxygen prescriptions warrant portable/ambulatory devices, but only 65 percent receive them. This is a huge issue.” Wilkinson believes the oxygen market is in transition from a delivery model to a non-delivery model, a transformation that started about 10 years ago with home transfilling systems. “Normally such a business model change would not take 10-plus years to materialize,” Wilkinson says. “Reimbursement uncertainties of competitive bidding stalled this transition, and we have been in a holding pattern for the past four to five years while providers wait and see if they will be able to stay in the market. Once we have clarity on reimbursement and competitive bidding, you will see the conversion to a nondelivery model accelerate.” But clarity could be a long-time coming, and experts see two scenarios that could ultimately play out. According to Jeff Woodham, MED’s senior vice president and general manager, one scenario is that reimburseWoodham ment will not recognize the value of the portable unit, therefore limiting its adoption in the marketplace. “We simply cannot afford to take any more cuts, no matter what delivery model you are using.” —Kelly Riley The MED Group “If payers do not accept that increased ambulation leads to better health outcomes, increased patient/caregiver satisfaction and more efficient health care provision,” says Woodham, “then portable technology probably does not get the traction needed for critical mass adoption.” On the other hand, MED’s Wayne Grau, vice president, contracting and business services, says CMS could someday Grau understand that new technol- ogy such as POCs must have price support to make sure the equipment can be provided and that manufacturers can still invest in research and development to make units better, smaller and less expensive. “We must reach critical mass so that the large investments that have already been made continue for the betterment of the patient,” says Grau. “Treating COPD is not just about getting them the oxygen, but helping to make lives better.” “Once we have clarity on reimbursement and competitive bidding, you will see the conversion to a non-delivery model accelerate.” —Scott Wilkinson Inogen Looking for HME Products, ManufacturErs, distributors or consuLtants? The annual HomeCare Buyers’ Guide is the industry’s most complete resource for home medical equipment professionals with thousands of items, hundreds of companies and more than 150 product and service categories. The HomeCare Buyers’ Guide is an issue to keep and use all year long when you’re searching for just the right product to fit your needs. Need information fast? Visit the Buyers’ Guide online at www.HomeCareMag.com. Point and click for company listings, contact information and hotlinks. nEEd Ex t ras? Call 866 /50 order ad 5-7173 to dit copies w ional supplies hile last. buyErs’ guidE 2011 42 | MAY 2011 | www.homecaremag.com When providers are certain of long term conditions, Wilkinson believes they will choose POCs over the more established modalities. “The weakest segment is liquid oxygen,” he contends. “It is expensive, requires specialized equipment and personnel, deliveries, and it is scary for patients.” These days, business conditions are scary for providers and manufacturers as well, but Wilkinson believes many in the industry will demonstrate a familiar resiliency through a combination of optimism and hard work. “I continue to think the future of the oxygen market is bright despite all the recent gloom and doom heard around every corner,” he says. “We have a growing patient market, we have new business models that are inherently lower cost than historical models, and the ‘consumerism’ of the oxygen market creates rewarding opportunities for marketing and product innovation.” Continues Wilkinson, “The key to success, whether you are an oxygen supplier or a manufacturer, will be to embrace change. Those that live in the past trying to preserve the status quo won’t be competitive, and they will die.” AAHomecare Update By Tyler Wilson Improving Mobility Policy New Medicare policies hamper access to mobility O ne of the principal goals of health care reform was to improve access to medical care and services, particularly for the most vulnerable in our society—the poor, frail, elderly and those living with disabilities. So it’s unfortunate and ironic that some new policies, including provisions in the health care reform law, have instead made it more difficult for Medicare patients to receive the mobility assistance that can help them remain at home living safely and independently at a lower cost to our health care system. continue to have access to these products and related services. Still, there are numerous burdens. Many providers now struggle when repairs are needed. In the past, Medicare fairly reimbursed providers for repairs, but the reimbursements have been slashed to the point that providers often lose money when fixing power wheelchairs for Medicare patients. As an unintended consequence of these policies, it’s getting harder for providers to supply the equipment and services that Medicare beneficiaries need. Recently AAHomecare surveyed more than 125 mobility providers across the country to learn how companies are adjusting to these Medicare policies. Many providers reported negative consequences such as no longer offering power wheelchairs or going out of A power wheelchair can be the key factor business. The survey found that: that allows Medicare beneficiaries to remain n 65 percent said their ability to service Medicare beneficiaries has been compromised; in their homes. n 48 percent said their repair policies have been negatively affected; and n 28 percent said their level of staffing has been cut. Policymakers often overlook the value of power wheelchairs In addition to addressing the regulatory challenges that to patients with mobility impairments. Most take mobility for providers face, mobility stakeholders have been pushing for granted. But a power wheelchair can be the key factor that alfederal legislation that would create a separate benefit catlows Medicare beneficiaries to remain in their homes. egory in Medicare for complex rehab technology. The curMobility providers have suffered a long string of obstacles rent Medicare HME benefit does not adequately differentiate and setbacks: the steep Medicare reimbursement cuts in complex rehab technology and the required, related servicrecent years, implementation of the problematic bidding es, and fails to adequately address the needs of individuals program, excessive and overreaching audits, confusing and with disabilities, consider the range of services furnished by inconsistent guidelines for documenting medical necessity complex rehab technology companies and incorporate the and elimination of the first-month purchase option, among complexity and unique nature of the equipment itself. others. Mobility providers across the country say they now Stakeholders working together on the separate benefit must determine whether it makes sense from a business include the Clinician Task Force, NCART, NRRTS, the Reperspective to continue providing power wheelchairs to habilitation Engineering and Assistive Technology Society Medicare patients. of North America and United Spinal Association as well as We occasionally make progress. In April, the DME AAHomecare. MACs allowed use of Advance Beneficiary Notices (ABNs) for Group 2 power operated vehicles and Group 4 power wheelchairs so that consumers can elect upgrades that best Tyler J. Wilson is president and CEO of the American Association suit their needs. The previous policy had the unintended for Homecare, headquartered in Arlington, Va. You can reach him at consequence of classifying these items as “non-covered” by tylerw@aahomecare.org. For more information on critical home care issues, visit the association’s Web site at www.aahomecare.org. Medicare, which meant that beneficiaries would have had to pay the full cost of these items since an ABN cannot be used HME professionals are committed to helping people living for non-covered items. with disabilities to improve their quality of life. When MediThe American Association for Homecare, National Coalicare policies create obstacles to care, the HME community tion for Assistive and Rehab Technology, National Registry needs to work together to fix the problems through regulaof Rehabilitation Technology Suppliers and other groups tions or legislation. AAHomecare accepts this challenge engaged CMS and the DME MAC medical directors seeking each day, and we welcome your support and assistance. revisions to this policy so that Medicare beneficiaries would www.homecaremag.com | May 2011 | 43 Washington Wit & Wisdom By cara c. bachenheimer Dear HME Provider If ever there was a time to get involved, it is now This month, columnist Cara Bachenheimer shares the following open letter to providers from Invacare Chairman Mal Mixon. Congress signed on as co-sponsors. If all of us devote just a small amount of time to this effort, we can move this bill through Congress. But to do so we need each and every one of you to ask your representatives to sign on to H.R. 1041. would like to take a moment to share my thoughts If ever there was a time to get involved, it is now. NCB is with you regarding the status of national competi- scheduled to be rolled out to an additional 91 MSAs on tive bidding, i.e. suicide bidding. July 1, 2013. Last year, 167 economists who are auction exThis is NOW. GET MAD! Do something about it. Contact perts agreed and stated to Congress, the Centers your representatives. Dial the U.S. Capitol switchboard at for Medicare and Medicaid Services and the 202/224-3121 and ask for your member’s office. Let him or public that the Medicare DME bidding program her know how this fatally flawed program will impact the in its current form is fatally flawed and must be stopped. patients that you serve. These independent experts highlighted what we’ve known Follow up in writing. Be specific. Talk about the job loss that will be related to this program and the potential for thousands of small businesses to close throughout the United States. Talk about patients being deWe can stop this thing. Congress nied access. And ask for the sale—ask your represenresponds to its constituents, but it cannot tative to sign on to H.R. 1041. respond if they don’t hear from you. Your national and state/regional associations, Invacare, VGM, The MED Group and industry leaders have been working tirelessly to end this ill-conceived all along: that the Medicare DME bid program will result in program. But we need all of you to be involved. Make a unsustainable low prices and lack of access. financial contribution to your state and national associaThis lack of access will have an incredibly damaging tions’ political action committees. Do something. impact on the patients you serve, many of whom are the There are 10,000 providers like you. We need you. We can weakest and most vulnerable in our society. There will be a stop this thing. Congress responds to its constituents, but negative impact on the quality of care that can be achieved it cannot respond if they don’t hear from you—each and in the home, and patients will most likely end up in hospievery one of you. tals or nursing homes. It truly is “United we stand, divided we fall.” When home care is the trifecta of health care—patient preferred, better clinical outcomes and one-fifth the cost Sincerely, of institutional care—a program that destroys it makes no sense and must be stopped. A. Malachi Mixon, III In addition to affecting patient care, NCB is a job-killing Chairman program. Thousands of jobs in the home care industry will Invacare Corporation be lost while the government says it is trying to do just the opposite—support the fragile ecoA specialist in health care legislation, regulations and government relations, nomic recovery. cara c. bachenheimer is senior vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of We are at a critical time and can now influence Epstein, Becker & Green in Washington, D.C., and at the American Association for the future of our industry. The bill that has been Homecare and the Health Industry Distributors Association. You can reach her at introduced in the U.S. House of Representatives, 440/329-6226 or cbachenheimer@invacare.com. The Fairness in Medicare Bidding Act of 2011 (H.R. 1041), is gaining traction in the House with about 90 A P.S. from Cara: If you need talking points or other assisco-sponsors (as of press time). tance in contacting your representatives, visit the websites of The bill would eliminate the ill-conceived bidding proyour national and state/regional trade associations or your gram—paid for fully, at no cost to the industry. buying group. You can also contact me at the phone number We need to escalate our efforts to get more members of or email address above. I 44 | May 2011 | www.homecaremag.com Sales Notebook BY LOUIS FEUER, MA, MSW Behold the Payer You are not in business to break even; you are in business to make a profit here is much to learn when embarking on a successful HME sales career. Learning how your operations department functions, the product lines you offer and the needs of the referral source are just the beginning. The key is selling products that generate income for your company and, ultimately, yourself. That’s something we must focus on if we are going to survive these difficult economic times. We are often concerned about the price the competition has set for the same product. We wonder if supply and demand make a difference in been excluded in some contracts. There could be products that are not covered at all, and for those, the patient might need to make a cash purchase. Take a look at each primary payer source and become familiar with the profits you get from the particular products you provide. You are not in business to break even; you are in business to make a profit. You cannot, as a salesperson, consider making a commission on the sale of products that do not generate a profit for the company. ■ List all the third-party payers you work with, and note those you do not or might not want to. If this information changes, make sure you are notified immediately. You don’t want to tell a referral source you accept a certain insurance when your agreement with You cannot, as a salesperson, consider payer has been cancelled. making a commission on the sale of products that ■ Learn about the types of patients your referral that do not generate a profit for the company. source works with primarily. If the source has a caseload of Medicaid patients and your product line is not covered by the state’s Medicaid plan, for example, you should know this information. how we should price our products. We consider as well what ■ If it is at all feasible, get to know the payers your comprice the marketplace might bear. pany works with and any payer representatives who might These are all interesting business concepts, but do any of these economic issues play a role in the home care industry? authorize or even deny your payments. ■ Often insurance companies employ case managers to Some do, but most pricing issues we must deal with come work on their more complex and difficult cases. While it handed down to us from a third-party payer. We often have may not be easy to meet these people in person, find out little understanding of the formula for price-setting, nor are whether the payer contracts with any independent case we at liberty to alter the price due to local trends or the ecomanagement companies that might be located in your comnomic environment. munity. Nothing beats a face-to-face meeting with the perNow that that has been clarified, what’s a salesperson to son who can authorize payment or challenge an order. do? The best we can do in order to be successful and profitAs a salesperson, this connection could prove invaluable. able is to understand as much as possible about the payer, the You might learn that with specific documentation, what was payment and the process we must follow in order to get paid. originally denied could now be listed a covered item. SomeIn fact, it’s all about the payer. Too many salespeople see times contracts do not have all the rules outlined, and some their role as one related to making the phone ring, creating can be discovered only through a face-to-face meeting. orders and locating new referral sources. Today, that may not be enough. In some companies the phone is ringing, but too often without the right type of Louis Feuer is president of Dynamic Seminars & Consulting Inc. and founder of order on the other end of the line. MedComment Center, an online program for surveying patients and referral sources. What must a salesperson learn before he or she You can reach him through www.medcommentcenter.com or at 954/838-7504. moves out to capture the right business in the “Sales” is about just that—sales. The problem is that while marketplace? Competitive bidding and the present reimthe sale might take place, the profit could be missing. You bursement environment make learning about products and must make sure that your sales are profitable. If they are not, payers even more important. Here are some strategies and find out why. We all understand there is value in helping to tasks to consider: ■ Make a list of contracts you have with any managed care solve a problem because of the seriousness of the need rather groups or payers. You want to know who is paying what for than our need to make money. But we are not a charity. The what. You could find that some products or services have time has come to get to know your payers, inside and out. T 46 | MAY 2011 | www.homecaremag.com BUY. LEARN. NETWORK. DO BUSINESS AT MEDTRADE. -`XW" October 25–27, 2011Conference" October 24–27, 2011 Georgia World Congress CenterAtlanta, GA Medtrade 2011 is where you need to be to strengthen your business, improve the care of your patients and receive the tools you need to do both. Over 600 Exhibitors Tens of thousands of products Over 120 Educational Sessions Stand Up for Homecare Fundraising Reception Power for Funding Networking Event Medtrade Accessible Home Retail Showroom Legislative Updates Opportunities for Advocacy Homecare works for patients. Medtrade works for you. medtrade.com O UT CO M ES BE TT ER E IV CT FE EF 8LI3JJMGMEP1EKE^MRISJ1IHXVEHI ST CO Produced by: Nielsen Expositions, a part of the Nielsen Company PATIENT PREFERRED Law School By Jeffrey S. Baird, eSq. More from PPACA you can’t run, you can’t hide from HHS’ new authority T here are a number of provisions that directly affect DME suppliers in the Patient Protection and Affordable Care Act, including offsetting payments to suppliers with the same tax ID numbers and the requirement that a supplier implement a compliance program. Under the health reform law, the Department of Health and Human Services can adjust payments to a provider or supplier that has the same tax mined by HHS, certain providers and suppliers will be required to establish a compliance program. The compliance program must contain core elements that will be established by HHS in consultation with the Office of Inspector General. There is no specific implementation timeline for HHS to establish the core elements. CMS has, however, solicited comments from the public as recently as Feb. 2, 2011, on issues pertaining to implementation of the core elements. Based on compliance program guidance for the HME industry published by the OIG in 1999 and on subsequent comments and guidance from the OIG, we can fairly accurately predict the core elements that the OIG will HME companies will need to watch expect to be included. recoupments and buy into the importance Existing OIG compliance guidelines for HME supof compliance. pliers list seven required elements of an effective compliance program: written policies and procedures; designation of a compliance officer and compliance ID number as one that owes past-due obligations under committee; conduct of effective training and education; deMedicare, Medicaid or CHIP, regardless of such providers’ or velopment of effective lines of communication; enforcement suppliers’ Medicare billing number or NPI. of disciplinary standards; auditing and monitoring; and For example, assume that an HME company has three response to offenses and corrective action. HME locations (each with a Part B supplier number), a sleep In order to be deemed “effective,” the compliance prolab and a home health agency. Assume these are divisions gram must be something more than a set of documents that of the HME company (they are not separate subsidiary corsimply restate these seven elements. These basic elements porations). Assume that one of the HME locations ends up must be specifically implemented by the HME company and owing a substantial recoupment to CMS. be designed to address its past, existing and future activities. In order to recover the recoupment, CMS may now offset Once HHS issues regulations—and a deadline—for comnot only against the supplier number for the one HME locapliance programs, HME companies will need to buy into the tion but also against payments to be made under the other importance of compliance. two HME supplier numbers, the sleep lab local carrier Part The OIG has warned that merely purchasing compliance B number and the home health agency provider number. policies is not enough: The right given to HHS to look at multiple supplier and provider numbers under the Jeffrey S. Baird, Esq., is chairman of the Health Care Group at Brown & Fortunato, P.C., a law firm based in Amarillo, Texas. He represents pharmacies, infusion companies, same corporate entity for offset is consistent home medical equipment companies and other health care providers throughout with CMS’ goal of not allowing a company the United States. Baird is board-certified in health law by the Texas Board of Legal or individual to escape its/his obligations by Specialization. He can be reached at 806/345-6320 or jbaird@bf-law.com. “hiding” behind a separate supplier number or corporate entity. “Implementing an effective compliance program requires PPACA states, for example, that providers or suppliers ena substantial commitment of time, energy and resources by rolling or re-enrolling in Medicare, Medicaid or CHIP will be senior management and by the DMEPOS supplier’s governsubject to new disclosure requirements. Applicants will be ing body. Superficial programs that simply have the aprequired to disclose current or previous affiliations, directly pearance of compliance without being wholeheartedly or indirectly, with any provider or supplier that owes money adopted and implemented by the DMEPOS supplier or proto a government program, has been excluded from particigrams that are hastily constructed and implemented without pating in federal health care programs or has had billing appropriate ongoing monitoring will likely be ineffective and privileges denied or revoked. could expose the DMEPOS supplier to greater liability than In another of the law’s directives, by a date to be deterno program at all.” 48 | may 2011 | www.homecaremag.com HME Products VMI Fiorella Platform Lift S9 VPAP Series ■ 30-in. usable platform width, 42-in. usable platform length; weight capacity 500 Ibs. ■ detachable control unit can be placed anywhere in the vehicle; LCD interface has a multi-language capability and produces visual messages for maintenance reminders ■ ResMed ■ series of bilevel devices incorporate a range of technologies to treat specific patient groups, including OSA patients who do not currently adhere to CPAP therapy, patients who need additional ventilatory assistance and complex sleep apnea patients ■ sleek and intuitive design for easy setup and use; enhanced Easy-Breathe technology and Climate Control system give users control over their own comfort settings; Climate Control humidification system intelligently adapts to environmental conditions to deliver optimal pressure and temperature; ClimateLine heated tube protects patients from rainout without compromising humidity or temperature levels ■ helps patients overcome the challenges of noncompliance with tools to proactively manage their own therapy; Sleep Quality Indicator allows users to view ongoing therapy progress; SD card and wireless modem capabilities anti-crushing sensor prevents the lift from injuring users www.vantagemobility.com ActiveCare Medical Cobalt X23 ■ lightweight, transportable power wheelchair; disassembles into three pieces with the removal of a single bolt using the included tool ■ smaller size suitable for patients with limited space in their homes ■ weight capacity 250 lbs. www.resmed.com www.activecaremed.com Lavin Lift Lift Strap ■ solution for securely suspending lower half of the patient’s body or limbs for offloading or treatment; strap gently elevates to give caregivers easy access ■ allows one caregiver to safely change and clean bedridden, incontinent or wound care patients more often ■ foam-padded nylon with Velcro and buckle attachments; designed to work with all standard patient lifters; ranges from 12 in. to 48 in. Sky Med SureStep Tip ■ cane tip casts a pool of light around the base of the cane to make walking at night or in low light conditions safer; wider base allows cane to stand on its own ■ waterproof base can be added to most standard 7/8-in. walking canes so user can upgrade an existing product; installation requires no tools; battery compartment opens easily with a coin for replacement; uses standard AAA batteries ■ automatic light sensor triggers at 10 lux, or twilight conditions; tip is lighted by four LED bulbs; cane automatically powers off when not in use www.lavinlift.com www.skymedint.com www.homecaremag.com | MAY 2011 | 49 Left Coast Sports Grip-n-Assist ■ belt worn around the waist; four grips to help leverage weight in accomplishing daily tasks such as standing up or sitting down, entering or exiting a vehicle ■ one size fits all; can be worn with handles facing front or back; caregiver can grab any of the grips when belt is worn by patient; when caregiver wears the belt, patient can hold grips to help reposition themselves or get up or down ■ lightweight, durable, breathable material for comfort; secured to the wearer by Velcro and buckle; belt is waterproof for help in getting in and out of the bath www.grip-n-assist.com Hill-Rom Gel Ovations P400 Therapy Surface ■ self adjusting alternating low pressure mattress replacement system with microclimate assistance ■ sleek integrated system; Sensory provides optimal therapy by adjusting pressures based upon position changes ■ eliminates potential misuse or accidental setting changes; no patient weights to enter, no cycle times to select, no comfort settings to adjust; gentle alternating cycle Dimensions Gel Toilet Seat Cover ■ easily applicable toilet seat cover provides pressure relief ■ allows air flow, reduces shear and pressure, doesn’t absorb water or odors and is easily cleaned and sanitized ■ designed to work with popular toilet seats; includes removable machine washable cover www.gelovations.com www.hill-rom.com ContaCt Us PHone 770/955-2500 Fax 913/514-3886 CUstoMer serviCe 866/505-7173 or 847/763-9504 (outside U.s.) national sales Manager Kent Peterson 972/517-3599 kpeterson@homecaremag.com editorial gail Walker, editor-in-Chief 770/618-0121 gwalker@homecaremag.com www.HomeCareMag.com 50 | MAY 2011 | www.homecaremag.com Gordon Ellis & Co. Dignity ■ mobile commode on wheels; usable in any room ■ plugs into household electricity supply; fill the reservoir from the nearest faucet ■ heated seat; warm water is gently sprayed to clean the user, and warm air to dry; waste is removed in the discrete potty or by using a hygienic absorbent plastic bag www.gordonellis.com Chad Therapeutics Troy Technologies Bonsai OM-808 Economy Travel Wheelchair ■ weighs 18 lbs. with a travel pouch and three-stage handle brake ■ available in 16- or 18-in. seat width ■ can be customized with a wide range of colored and patterned seat and back fabrics; sports lovers have the option of several team fabrics for NBA and NFL teams to choose from www.travelwheelchair.net ■ pneumatic conserver weighs 9.7 oz. with up to a 6:1 savings ratio and operating pressure range of 200–3,000 PSI ■ delivers oxygen in the first half of the inspiratory cycle, ensuring O2 saturation at 93 to 96% ■ uniform pulse design reduces the risk of desaturation www.chadtherapeutics.com Ideal for those in home health care or assisted living environments. 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Call or visit to learn more about our full line of products today. 800-648-1256 | www.flexabed.com Made in the USA www.homecaremag.com | MAY 2011 | 51 VGM will hold its 10th annual Heartland Conference June 6-9 at the Five Sullivan Brothers Convention Center in Waterloo, Iowa. INDUSTRY Calendar 11-15 June Associated Professional Sleep Societies (APSS) SLEEP 2011 Minneapolis, Minn. 708/492-0930 www.sleepmeeting.org 5-8 Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) Annual Conference Toronto, Ontario, Canada 703/524-6686 www.resna.org 15-17 North Carolina Association for Medical Equipment Services (NCAMES) Summer Meeting and Exhibit Wrightsville Beach, N.C. 919/387-1221 www.ncames.org 6-9 VGM Group Heartland Conference Waterloo, Iowa 800/642-6065 www.vgm.com July 8-11 17-19 American Physical Therapy Association (APTA) Annual Conference National Harbor, Md. 800/999-2782 www.apta.org ADVERTISER COMPANY NAME/WEB SITE Georgia Association of Medical Equipment Suppliers (GAMES) Annual Convention Savannah, Ga. Index Courtesy VGM 770/578-3999 www.gameshme.org 18-20 American Association for Respiratory Care (AARC) Summer Forum Vail, Colo. 972/243-2272 www.aarc.org August Summer Meeting and Exhibit Virginia Beach, Va. 919/387-1221 www.vadmec.org 11 Arizona Medical Equipment Suppliers Association (AZMESA) Annual Convention Phoenix, Ariz. 651/439-2944 www.arizonamesa.org 9-11 Virginia Association of Durable Medical Equipment Companies (VADMEC) For additional industry events, visit www.HomeCareMag.com and click ÒHME Industry CalendarÓ in the Quick Links box. This advertising index is provided as a service to our readers. While every effort is made to maintain accuracy, HomeCare cannot be responsible for errors or omissions. PAGE NO. PHONE NO. Accreditation Commission for Home Care/achc.org . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 . . . . . . . . . . . . . . . . . . . . . . . . . . . .919-785-1214 AirSep/www.airsep.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-874-0202 Arkray/www.glucocardusa.com/hme1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-848-0614 CHAD Therapeutics/www.chadtherapeutics.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-423-8870 Circadiance/www.circadiance.com. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 . . . . . . . . . . . . . . . . . . . . . . . . . . . 724-858-2837 Compliance Team Inc., The /www.exemplaryprovider.com. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 . . . . . . . . . . . . . . . . . . . . . . . . . . . 215-654-9110 Diabco/www.AR-Express.net. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-864-6210 Dr. Comfort/www.drcomfort.com. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 . . . . . . . . . . . . . . . . . . . . . . . . . . . 877-352-7833 EZ-ACCESS/www.ezaccess.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-451-1903 Flex A Bed, Inc./www.flexabed.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 . . . . . . . . . . . . . . . . . . . . . . . . . . . 808-648-1256 Health Law Center/www.healthlawcenter.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 . . . . . . . . . . . . . . . . . . . . . . . . . . . 864-676-9075 HQAA/www.hqaa.org . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 . . . . . . . . . . . . . . . . . . . . . . . . . . . 866-909-4722 Luggie Scooter, Inc./www.luggiescooter.com. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 . . . . . . . . . . . . . . . . . . . . . . . . . . . 877-968-6668 Mason Medical Products/www.masonmedical.com. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IBC . . . . . . . . . . . . . . . . . . . . . . . . . . .800-233-4454 McKesson/www.mckesson.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IFC . . . . . . . . . . . . . . . . . . . . . . . . . . .800-446-6380 Medtrade/www.medtrade.com. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47 . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-933-8735 Pain Management Technologies/www.jstim.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-239-7880 SeQual/www.sequal.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-826-4610 Sprint/Nextel/www.sprint.com/4G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-SPRINT-1 Team DME!/ www.teamdme.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BC . . . . . . . . . . . . . . . . . . . . . . . . . . . 888-832-6363 REPRINTS: Contact Penton Reprints (www.pentonreprints.com) to purchase quality custom reprints or e-prints of articles appearing in this publication at 888/858-8851, or e-mail reprints@pentonreprints.com. Instant reprints and permissions may be purchased directly from our Web site; look for the iCopyright tag appended to the end of each article. PHOTOCOPIES: Authorization to photocopy articles for internal corporate, personal or instructional use may be obtained from the Copyright Clearance Center (CCC) at 978/7508400. Obtain further information at www.copyright.com. ARCHIVES AND MICROFORM: This magazine is available for research and retrieval of selected archived articles from leading electronic databases and online search services, including Factiva, LexisNexis and ProQuest. For microform availability, contact National Archive Publishing Company at 800/521-0600 or 734/761-4700, or search the serials in microform listings at napubco.com. 52 | MAY 2011 | www.homecaremag.com homecarewebsitedirectory For a convenient way to get news and go shopping, check out the internet addresses of leading manufacturers in the hme industry. ONE Data Conversion | That’s Right on Target One Software Solution | One Conversion When switching software systems, a complete and seamless conversion is critical. Computers Unlimited guarantees 100% data accuracy. Learn how our unique approach has helped over 950 users move to TIMS in the last two years! Talk to an expert! www.timssoftware.com | 406.255.9500 | www.cu.net Your O2 Conserving Experts s P N E U M AT I C s ELECTRONIC s DISPOSABLE We can help you meet the diverse needs and preferences of your oxygen patients! 800-423-8870 s www.chadtherapeutics.com An MHA Company Connecting Partners, Delivering Results TM FIGHTING FOR YOUR SUCCESS The MED Group and MHA (Managed Health Care Associates, Inc.) have combined forces to become the largest Group Purchasing Organization in the Alternate Site Health Care Industry. Call The MED Group at 1-800-825-5633 or visit us online at www.medgroup.com to see how we can help your business increase profits and reduce costs today! Looking for satisfied customers? Higher margins? Look no further than Flex-A-Bed If your customers are searching for the perfect night’s sleep, then the answer is a Flex-A-Bed adjustable bed. Hand built by expert craftsmen in LaFayette, GA, using the same principles of care and consideration that we have built our reputation on since 1969, our adjustable beds are welcoming, durable and comfortable — your customer’s bed for life. Many retailers have told us that Flex-A-Bed’s 100 square feet of space is the most profitable part of the showroom ...and quite possibly their favorite sale! We invite you to learn more about our full line of products by visiting our Web site or calling us today. 2ESPIRATORYSLEEPDISORDEREDBREATHINGCRITICALCAREAND OPERATINGROOMPRODUCTS WWWFPHCARECOM www.homecaremag.com HomeCare may 2011 53 HOMECARECLASSIFIEDS For advertising information, contact Kent Peterson ■ p: 972-517-3599 ■ e: kpeterson@homecaremag.com CONSULTING SERVICES HUBSCRUB ACCREDITATION COMPLIANCE CONSULTING & POLICY MANUALS t "VUPNBUFZPVSFRVJQNFOUDMFBOJOH t 4BWJOHTTUBSUUIFmSTUEBZ t )6#4$36#SFOUBMTBWBJMBCMF Sleep Labs, New or Existing DMEPOS providers, we have solutions for you. New business development, compliance review or accreditation preparation consulting. More ways to reduce costs. HUBSCRUB.com 877-482-7278 EQUIPMENT FOR SALE/REPAIR Our experienced consultants are available for your assistance. Comprehensive Policy & Procedure Manuals compliant with AASM, ACHC, CHAP, HQAA and JCAHO standards starting from $695.00 Contact us at www.DMEConsultLLC.com or 800-713-7630 http://homecaremag.com/ • Marketing Opportunities • Online Opportunities • Subscriber Information • Classified Rates LOOKING TO FILL A POSITION IN YOUR COMPANY? To post a job opening in the HomeCare classifieds, contact: Kent Peterson at 972-517-3599 kpeterson@homecaremag.com 54 HOMECARE ■ MAY 2011 • Production Specifications • Much More! www.homecaremag.com HOMECARECLASSIFIEDS For advertising information, contact Kent Peterson ■ p: 972-517-3599 ■ e: kpeterson@homecaremag.com EQUIPMENT FOR SALE FOR SALE 100 LIQUID OXYGEN TANKS AND RESERVOIRS H-46’S, PB41, CAIRE $200.00 EACH HELIOS - 300/50 PIECES $200.00 EACH 100 CONCENTRATORS INVACARE, AIRSEP, RESPIRONICS $50.00 EACH ALL THIS EQUIPMENT IS IN GOOD WORKING CONDITION CONTACT ANDY AT (702)368-3003 or (702)348-8715 DON’T Wait to Advertise in HomeCare Magazine Contact Kent Peterson at 972-517-3599 or kpeterson@homecaremag.com Text only ads = $2.00/word Rates per Column Inch: 1 col* x 2 inches= $150.00 $60.00 for each additional inch of space *One Column Inch = 2.125” wide www.homecaremag.com HOMECARE ■ MAY 2011 55 On the Front Friends Complete Second LA Marathon D oug Shull, a quadriplegic from Morton, Ill., and his lifelong friend Chris Ackerman ran the Honda LA Marathon on March 20 with the help of a wheelchair donated by ATG Rehab. The donation was part of the 12-year-old company’s ongoing commitment to support those with disabilities and the 27 local communities the provider serves across the country, according to Cody Verrett, vice president, sales and marketing. Shull, 54, and Ackerman, 53, were running mates in high school before a swimming accident left Shull paralyzed at age 16. But their friendship continued over the years, and Ackerman asked Shull to compete in the marathon with him in 1986. “He had In a repeat performance— 25 years after their first LA Marathon—Chris Ackerman (left) and Doug Shull crossed the finish line again this year. 56 | May 2011 | www.homecaremag.com this great idea that we could finally do our race together, with him pushing my wheelchair 26 miles,” Shull told a local news reporter back then.. This time around, the friends decided to repeat the journey to raise money for World Vision, a children’s charity. Tackling the marathon 25 years later required some nifty networking to locate a custom manual wheelchair to borrow for the run, but when ATG Rehab received the call, its Cerritos, Calif., office sprang into action. Quantum Rehab manufactured the specially outfitted Litestream XF ultralight manual wheelchair, and ATG customized and fit the chair for Shull, fabricating a custom push handle for the back of the chair. The ATG team performed several test runs in order to calibrate the handle to allow Ackerman to reach full stride while safely pushing Shull. With additional help from pushers Tim Osti, Matt Stevenson and Hannah Ackerman—and through a torrential downpour that began at mile four—the two friends crossed the finish line this year in 4 hours and 47 minutes. Troy Kubinski, general manager of ATG’s Cerritos office, said supporting Shull and Ackerman in their endeavor was a reward in itself. “We are thrilled to have played a very small part in helping Doug and Chris pull off a truly incredible feat,” Kubinski said. “Their story transcends physical accomplishments and disability and demonstrates a bond that only a lifelong friendship can achieve.” AS 5000 LS/AS 8800 LOW AIR LOSS & ALTERNATING PRESSURE MATTRESS SYSTEM LOW AIR LOSS & ALTERNATING PRESSURE MATTRESS • Low air loss mattress with alternating pressure mode. • Cell-on-cell design keeps bottom half of 8” bladders inflated in case of power failure. • Static function to allow treatment of patient. • Microprocessor pressure sensing technology to produce low pressure support. • Pressure range adjusted by patient weight. • Warranty: 12 month. • Weight capacity: 350 lbs. EO277 • Low air loss mattress with alternating pressure mode. • 20 (8”) bladders for optimum pressure relief. • Static function to allow treatment of patient. • Soft/ firm dial to obtain custom comfort level by patients weight. • Audio and visual low pressure alarms. • Removable, non-shear, anti- microbial nylon cover. • CPR valve for rapid deflation. • Warranty: 12 month. • Weight capacity: 300 lbs. EO277 LS 9000B BARIATRIC LOW AIR LOSS/ ALTERNATING PRESSURE MATTRESS • Powerful Powerloft Pro Pump unit supports up to 1,000 lbs. (sizes 42”, 48”). • Dual functions combining low air loss and alternating • 6 airflow settings allow custom pressure selection for individual patient’s needs. • Static function to allow treatment of patient. • Microprocessor pressure sensing technology produces low pressure • 2 CPR valves for rapid deflation. • Warranty: 12 months. EO277 TM SIERRA GEL OVERLAY TM BALANCED AIRE PREMIER ONE EO185 K0734 E2601 • Optimal environment for prevention/treatment of pressure sores • One-piece construction requires no assembly • Easy to clean, non shear/low friction surface • Elastic corner straps to secure overlay to mattress • Base Foundation is a high density solid one-piece foam constructed core • Convoluted high density polyurethane foam topper The Balanced Aire Adjustable air cushion is constructed of independent flexible interconnected air cells designed to immerse the patient to help disburse pressure evenly and increase blood flow to assist in the treatment and prevention of pressure sores. The waterproof, 4 way stretch cover provides low shear to help maintain sensitive skin tissue while the air pump will be used to adjust individual patient comfort. The non-skid bottom and adjustable strap offers additional security. Available in a low profile 2” cushion. Designed specifically to reduce interface pressure and maintain skin integrity. The entire cushion is made of LuratexTM foam. LuratexTM is a revolutionary patented high resilient aerated foam. The formulation allows air to pass through the foam to keep the patient cool, dry and comfortable. The covers are available in stretch knit or waterproof nylon. Mason Medical Products 85 Denton Ave, New Hyde Park New York 11040 • Tel: 800/233-4454 Ext.516 • Fax: 516/328-6622 P: 888.832.6363 • www.teamdme.com • info@teamdme.com