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
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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.
By Greg Thompson
American Society of Healthcare Publication Editors
Best Case History 2009
Best Legislative/Government Article 2008
Best E-Newsletter 2006, 2007, 2008, 2009
Magazine Association of the Southeast
Best Magazine Web Site 2009
Best Essay 2005, 2006, 2008, 2009, 2010
Best Single Issue 2008
Best Service Journalism 2004
Best Article Series 2003
Best E-Zine 2003
Friends Complete
Second LA Marathon 56
Western Publications Association
Best Non-Paid Trade Magazine 1993-2002
Best Overall Trade Magazine 1996
Lifelong friends tackle the 26-mile
run—25 years after they did it the
first time.
American Society of Business Publication Editors
Magazine of the Year 1999
Best Magazine Redesign Award 1997
American Business Media
Jesse H. Neal Award - Best Single Issue 1998
HomeCare® magazine, May 2011, Vol. 34, No. 5 (ISSN 0882-2700, USPS 456-630) is published monthly by Penton Media, Inc., 9800 Metcalf Ave., Overland Park, KS 66212-2216; 913/341-1300, 800/5434116; fax: 770/618-0204. Periodicals postage paid at Shawnee Mission, KS and at additional mailing offices. Canadian Post Publications Mail Agreement No. 40612608. Canada return address:
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2
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MAY 2011
|
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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
|
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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.
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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
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MAY 2011
|
www.homecaremag.com
My Name:
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My Occupation:
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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
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|
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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
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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
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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.
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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
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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
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May 2011
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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.”
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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
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|
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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
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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.
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the Burbank, Calif., provider. 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
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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.
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www.homecaremag.com
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MAY 2011
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29
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Seating & Positioning
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COMING UP IN
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Respiratory Products
30
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MAY 2011
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www.homecaremag.com
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34
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MAY 2011
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www.homecaremag.com
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xygen delivery systems may
be the least understood and
least appreciated machines
in the eyes of government
regulators. 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
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“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
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logged onto
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today?
After you’ve read HomeCare magazine, there’s even
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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?
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42
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MAY 2011
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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
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May 2011
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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
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MAY 2011
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www.homecaremag.com
BUY. LEARN. NETWORK.
DO BUSINESS AT MEDTRADE.
-`XW" October 25–27, 2011ŒConference" October 24–27, 2011
Georgia World Congress CenterŒAtlanta, 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
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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.
The Redesigned Hi-Low Model
Our new line has been carefully crafted to make Flex-A-Bed the most desirable adjustable
bed on the market. Our updated Premier mattress is thicker and more luxurious than ever,
and our optional low profile mattress reduces minimum bed height to 19 inches. With
whisper-quiet lift and massage technology by Linak®, the new Flex-A-Bed has gotten rave
reviews from dealers and consumers alike.
Premier
Value-Flex
Hi-Low
We offer a full line of beds designed
to suit every customer’s needs.
Flex-A-Bed is your customers’ answer to the perfect night’s sleep. We continue to build
every bed in the USA, using the same principles we’ve built our reputation on since 1969.
And with profit margins of up to 120 percent, we think Flex-A-Bed
will not only be your most profitable, but also your favorite sale.
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
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52
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MAY 2011
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www.homecaremag.com
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HomeCare

may 2011
53
HOMECARECLASSIFIEDS
For advertising information, contact Kent Peterson
■
p: 972-517-3599
■
e: kpeterson@homecaremag.com
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MAY 2011
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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
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LOW AIR LOSS & ALTERNATING
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LOW AIR LOSS & ALTERNATING
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• Low air loss mattress with alternating
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The Balanced Aire Adjustable air cushion is constructed of independent flexible interconnected air cells designed
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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