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| May 16, 2011 | Volume 17, Number 19 |
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ADVERTISEMENT How Efficient Are You? Companies doing well in today's environment have streamlined their workflows, eliminated unnecessary tasks, optimized their business software and have set goals to measure their key functions. For HME and respiratory suppliers this usually equates to revenue per employee $165,000 or greater, DSO well below 60 and bad debt under 5%. If your organization is still struggling to achieve these industry benchmarks call us today at 954-757-3121 to find out how we can help. www.ancorconsulting.com Table of Contents - Round 1 Briefing Is 'More Lipstick on a Pig' - Medicare Trust Fund Kaput in 2024 - Competitive Bidding: Trying to Stop the Train - Steering Committee 'Making Progress' on Complex Rehab Benefit - Upstate Adds AHP Infusion Pharmacy - Patient Recruiter Cruised Lobbies of Senior Housing - Praxair Acquisition Pays Off for Apria - Liberator Sales Shoot Up 31 Percent - Rotech Improves Profitability in Q1 - Warrior Games Begin Today; Invacare Donates to Storm Victims; More News in Brief For more industry news, features and highlights from our latest issue, please visit our Web site at www.homecaremag.com. - Headline News Round 1 Briefing Is 'More Lipstick on a Pig' WASHINGTON—CMS took an airbrushed picture of Round 1 competitive bidding to Capitol Hill last week, but the distorted image could end up working in the HME sector’s favor, some stakeholders believe. At a congressional staff briefing on the five-month-old program May 10, CMS representatives said it was moving along more smoothly than anticipated with “virtually no complaints.” Repeating numbers relayed at a Program Advisory and Oversight Committee meeting in early April, agency officials said of 54,000 “inquiries” to the Medicare hotline, only 43 were complaints about bidding. It was a case of “more lipstick on a pig,” according to the American Association for Homecare. “Senate staff pressed CMS to describe the difference between a complaint and an inquiry but the agency was unable to give a suitable answer,” the association reported in its May 11 newsletter. “CMS is misrepresenting and misinforming Congress,” added John Gallagher, vice president of government relations for Waterloo, Iowa-based VGM Group. “The more they do that, the more I think it [works] for our side.” According to VGM sources, CMS told congressional staffers that clinical outcome concerns never materialized, that 97 percent of suppliers had experience in their localities and 76 percent of suppliers had experience in the specific DME service in the locality. Such assertions defy reality, Gallagher said. Industry providers have also disputed those figures since Round 1 contract suppliers were announced in November 2010. “In the Pittsburgh CBA, we have a substantial number of contractors from other states—Ohio, California, Tennessee, Florida, etc.,” Georgie Blackburn, vice president of government relations for bid winner Blackburn’s Pharmacy in Tarentum, Pa., told HomeCare in an interview following the announcement. “It’s incredible that so many contractors are from outside our state and/or have never supplied the product for which they won an award.” Various organizations have also reported cases of Medicare patients in bidding areas being unable to find a provider to supply or fix equipment. Gallagher noted specifically the story of a Florida woman who battled for a month to find someone to service her oxygen concentrator. Gallagher said he did not believe most in Congress are buying CMS’ rosy picture of competitive bidding. While legislators who support the bid program will likely accept it, others are skeptical, he said. According to VGM, officials at the Capitol Hill briefing also said that CMS: • Will survey beneficiaries in the Round 1 CBAs this summer to ascertain changes in the level of service and quality of equipment. • Is evaluating ways to improve bona fide bid rules and analyzing mean bid vs. pivotal bid methodology. The latter would mean fewer suppliers and higher costs, the agency warned. • Is also evaluating “a more realistic estimate” of overall supplier capacity, which would further limit supplier participation. • Did not know how many contract winners have gone out of business and is not tracking that data. Last week, VGM, AAHomecare and other industry associations urged providers to press their legislators for support of H.R. 1041 to repeal competitive bidding and to create a companion bill in the Senate. As of Friday, 97 cosponsors had signed on to the measure in the House. “While concerns about the program continue to grow in the Senate, more work is needed,” AAHomecare told members in a May 13 update. “It is imperative that you contact both of your U.S. senators to describe the problems with the Medicare bidding program for home medical equipment and services. Let your senators know the devastating effect that ‘suicide bidding’ will have on you and your patients.” He thinks “there is a very good chance” for a Senate bill, Gallagher said, noting that Friday’s report from the Medicare trustees underscores the need for a particularly well-run agency to handle Medicare. According to the report, the Medicare Part A trust fund will run out of money in 2024, five years earlier than anticipated. (See story in this issue.) “CMS is woefully inefficient,” Gallagher said. “That needs to be addressed. The more that builds, the more they lose credibility, the more we have a chance … “I think we just continue to highlight the absurdity of CMS’ claims,” he said. “You talk with members of Congress, they all want to dismantle CMS and start over. It’s nonfunctioning. Blow it up and start over.” How much of your business comes from retail? To vote in HomeCare's monthly Web poll, visit www.HomeCareMag.com. Medicare Trust Fund Kaput in 2024 WASHINGTON—The Medicare Part A hospital insurance trust fund will be exhausted in 2024, five years sooner than was predicted last year, according to the Medicare Board of Trustees. The trustees blamed the earlier date on the country’s economic downturn, which has resulted in lower tax revenues to finance the trust fund. The annual report, released Friday, showed the fund’s income was $486 billion in 2010, but expenditures were $523 billion. In fact, the trustees said, fund expenditures have exceeded income annually since 2008 and are projected to continue doing so until, in 2024, dedicated program revenues would only be able to pay 85 percent of Medicare Part A costs. At a press briefing, Treasury Secretary Timothy Geithner said the report makes it clear that legislators must act on entitlement programs soon or be forced to impose tax increases, deep cuts to benefits or both. Without the changes in the Affordable Care Act, the fund would be depleted even sooner, in 2016. As for Medicare Part B, the supplemental medical insurance trust fund is adequately financed at least over the next 10 years because premium and general revenue income are reset each year to match expected costs, the trustees said. However, they noted in the report, Part B costs have been increasing rapidly. An average annual growth rate of 4.7 percent is projected for the next five years, but that rate “is unrealistically constrained due to a physician fee reduction of over 29 percent that would occur in 2012 under current law,” the trustees said. “If Congress overrides this reduction, as they have for 2003 through 2011, the Part B growth rate would instead average 7.5 percent.” While Medicare’s financial outlook has been “substantially improved” as a result of changes in the ACA, the trustees wrote that in the long range, “much of this improvement depends on the feasibility of the ACA’s downward adjustments to future increases in Medicare prices for most categories of health care providers.” As of 2010, 47.5 million people were covered by Medicare, including 39.6 million aged 65 and older, and 7.9 million disabled. Read the full report at www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2011.pdf. Competitive Bidding: Trying to Stop the Train NORCROSS, Ga.—Adding new technologies, diversifying into new service lines and scouring your business for efficiencies can definitely help prepare for competitive bidding, according to provider Todd Tyson, president of Hi-Tech Healthcare. But the changes won’t be instant. “Don’t think you just turn on a switch and everything works tomorrow,” Tyson said. “It takes a lot of work to get prepared for this.” For the past three years, Tyson has embraced automation, outsourcing and expansion to buffer his business from the bid program’s effects, he said. As a member of the Georgia Association of Medical Equipment Services, the Committee to Save Independent HME Suppliers and the American Association for Homecare, he has also worked hard in support of efforts to derail the program. “We all see the train coming, so we are still in that effort of trying to prepare and being engaged to try and learn more about what to do and be ready for it,” he said. For starters, Tyson said, “We’ve looked for every efficiency we can find in our business.” Based in Norcross, an Atlanta suburb, with eight locations, Hi-Tech has improved time management with flex schedules and overtime monitoring, centralized intake with emphasis on “clean in, clean out,” and incorporated both GPS routing and new handheld point-of-delivery devices. A central dispatch has “one person watching every one of our drivers and every vehicle move live in real time,” Tyson said. After converting to eFax, “we have seen our DSO reduced by 10 days,” he said. The company has also outsourced CPAP supply replacement, “so we’ve got a zero inventory” with no dead inventory sitting on the shelves. In times like these, Tyson said, you can’t allow any savings to fall through the cracks. Historically focused in the respiratory sector, the 21-year-old company has transitioned to non-delivery systems for oxygen. But it has also moved into services “such as simple power and other things we’ve never done before,” said Tyson, including expansion into some service lines outside of Medicare. “Our biggest thing now is trying to put away some cash,” he said, referring to the continuing credit crunch. “I don’t necessarily want to slow our growth, but my biggest fear is that we would grow faster than I could finance … because my bank certainly won’t give me any more money.” With all of the changes, Tyson said, “I feel pretty confident that if [the next round] doesn’t bid to the bottom, we’ll survive it. I hope we would win at least one or more of the locations, and if we don’t, we’re diversified enough outside that that we could survive.” The company has expanded geographically, too, recently opening a location in Birmingham, Ala.—its fifth inside a Round 2 CBA. With existing branches in metro Atlanta and Chattanooga, Tenn., that gives Hi-Tech shots at three bid areas in Round 2. “Hopefully we’ll get three bites of the apple,” Tyson said. “I just hope it’s not the poison apple.” His best hope about competitive bidding, though, he added, is that more providers will join the fight against it. “Get involved, get engaged and … keep trying to stop this train,” he urged. Steering Committee 'Making Progress' on Complex Rehab Benefit BUFFALO, N.Y.—If you think getting a bill through Congress is easy, just check the steps involved in securing legislation that would create a separate Medicare benefit for complex rehab. According to Don Clayback, the steering committee working on the benefit is “making progress in accordance with our 2011 plan.” Draft legislation has been written, clinical groups including the American Occupational Therapy Association (AOTA) and the American Physical Therapy Association (APTA) have signed on to support the initiative, and an independent economic research firm is working on the estimated cost for the legislation. But there’s still a lot of work to do. In a May 10 update, Clayback, steering committee chair and executive director of NCART, outlined the hurdles left to jump in the process: 1) Obtain bipartisan commitment to introduce the needed legislation from two members of Congress (one Democrat and one Republican). This is our immediate focus and will involve discussions on the details of our issues, the draft language, the related costs, and the potential offsets to allow the bill to be budget-neutral. 2) Next, the draft legislation (with any desired modifications) will be sent to the Office of the Legislative Counsel in Congress so that it can be reviewed, edited, and prepared for formal introduction. 3) Once the legislative language is finalized, it will be formally introduced and assigned a bill number. This is a critical achievement, because once we have a bill introduced we can then most effectively engage all stakeholders in grassroots efforts focused on that specific bill number to garner additional cosponsors. 4) Upon introduction the bill will be referred to a committee of jurisdiction. There it will be subject to additional review. 5) At some point (before introduction or after introduction) the bill will be forwarded to the Congressional Budget Office for their official scoring of the projected financial cost over a 10-year period. 6) Finally, with enough congressional support, our legislation will be attached to a larger bill and be brought to the floor of the House and/or Senate for a vote. It needs to be passed in both chambers and then sent on to the president for signing. Once passed and signed we have accomplished our legislative objective and can move on to the implementation. Once legislation is passed, Clayback explained in the update, “we will be working with CMS on the implementation of the legislation and the development of related policies and other changes.” Said Clayback, “At the start of this year we stated our efforts in 2011 need to be viewed as a marathon, not a sprint. So stay hydrated and pace yourselves.” Upstate Adds AHP Infusion Pharmacy Home infusion is growth path for some, experts say, but tough if you’re not already in the market CLINTON, N.Y.—In a strategic move to blunt the effects of competitive bidding, Upstate HomeCare announced May 9 it has purchased the American HomePatient infusion pharmacy in Rochester, N.Y. The deal is expected to close within 30 days. The addition expands Upstate’s presence in upstate New York, and will add 18 to 20 jobs, or about 15 percent, to the provider’s current work force of 125. The company’s Rochester location, which houses two pharmacies, will be expanding to accommodate the acquisition. “We need to increase the bottom line because competitive bidding is not going to go away,” said Greg LoPresti, vice president and COO. “This acquisition follows our plans to grow strategically and, in a scalable way, to provide needed efficiencies.” The acquisition was a strategic move for AHP, as well. “We chose to exit our home infusion pharmacy business in Rochester in order to continue our strategy of focusing on our core business of providing in-home respiratory services and [DME],” said Rena Powers, general manager of the AHP Rochester branch, in a release. Acquiring AHP’s infusion pharmacy is the latest expansion for Upstate. Headquartered in Clinton, N.Y., with locations in Utica, Syracuse, Rochester, Canandaigua and Buffalo, the company provides pharmacy and home infusion, specialty medications, respiratory and DME. Eight months ago, the provider expanded its Clinton business and has also broadened its Buffalo location to offer complete infusion services, LoPresti said. Last fall, Upstate completed the acquisition of Mohawk Valley Home Care in Utica, a respiratory and DME provider. “It’s all part of our strategic plan so we can have economies of scale to compete,” LoPresti said, noting that Upstate will be in Round 2 of competitive bidding. “We wanted to be ahead of the curve.” LoPresti said the infusion business has been a good niche for Upstate, a 26-year-old company that first entered the sector in 1997. It offers some synergies with the company’s respiratory therapy arm and its DME business, as well as its home health agency, and over the years, the infusion sector has helped the company to grow, he said. “We are well positioned. We are a mid-level company and we have buying power that some moms-and-pops do not have,” LoPresti said. Adding the AHP pharmacy made sense, he said, because Upstate had an infusion business and “we are already established.” Upstate hasn’t been the only company that sees infusion as an attractive sector. “We’ve seen quite a bit of activity in the infusion space, more from people who do infusion as opposed to those [only] in home medical equipment,” said Rich Glass, president of Tarpon Springs, Fla.-based Steven Richards & Assoc. Why the interest? “There are a couple of factors,” said Reg Blackburn, managing director for Pittsburgh, Pa.-based The Braff Group. “It’s a very stable merger-and-acquisition sector … and that makes it attractive. And infusion has to be delivered locally.” It makes sense for companies that want to grow to purchase other infusion companies in a targeted geographic area, Blackburn said, noting that most buyers are regional or national companies that have already established home infusion platforms. Private equity firms are also interested in the sector. Private equity firms “are somewhat opportunistic to … what happens with reimbursement,” said Jonathan Sadock, managing partner of Paragon Ventures, Philadelphia. “They still see [infusion] as a good, solid business with a very strong increase in demand, which is an expansion opportunity for them.” So is infusion a good sector for an HME company looking to bolster its bottom line in preparation for reimbursement cuts or loss of other business under competitive bidding? Not necessarily, say the experts. “You have to have a certain amount of scale—somewhere in the neighborhood of $5 million a year,” said Glass. “It’s a totally different type of business from HME. You have to hire a pharmacist and it’s a different group of payer contracts, as well … Generally, if you’re making the jump from HME, it is not so easy.” “You do have to have a [compliant] clean room,” added Blackburn, referring to the sterile rooms for compounding of medication. “You have to have the right equipment to do that. You have to have access to the right managed care contracts. Those are things that are somewhat the barrier to entry. They are not insurmountable, but they make it less appealing.” Sadock agreed there are barriers to entry for HME companies that have no infusion business. However, he believes there are also some advantages that providers might want to consider. “The home infusion business model can offer HME companies synergistic value by expanding utilization of existing infrastructure and diversification of both products and payers,” he said. “The home infusion sector and HME share some commonality in terms of the back office function and some of the sales functions.” In addition, he said, HME companies “can really use the diversification and payer mix that home infusion affords them.” Home infusion—and other niche markets—are worth exploring for HME companies, according to Sadock. “The ones that are doing it are the ones that are proactive in making something happen. The ones sitting idly by and seeing competitive bidding erode their business to nothing I hope are the minority in this situation,” he said. “With what’s going on in the HME industry, if you’re not looking to diversify and to expand your market and increase the use of the infrastructure that you have developed—the people, the systems, the back office—if you’re not absolutely maxing it out or looking for ways to max it out in the current environment, I’m not sure how you will survive.” Patient Recruiter Cruised Lobbies of Senior Housing SAN FRANCISCO—An Oakland, Calif., woman was sentenced April 26 to 57 months in prison for her role in a scam to bill Medicare for more than $1.2 million in fraudulent claims for power wheelchairs, HHS and the Department of Justice announced. Donna K. Wells, 52, was convicted in November 2010 of health care fraud after a week-long jury trial in the Central District of California. In addition to her prison term, U.S. District Court Judge Dale S. Fischer sentenced Wells to three years of supervised release and ordered her to pay $240,380 in restitution. According to beneficiaries who testified at her trial, the lengths to which Wells went in enticing them shows just how far some scammers will go. Prosecutors said Wells worked the streets and low-income, senior living communities of Oakland in her recruiting effort. Beneficiaries who testified said Wells approached them on the street, at the store or even waited in the lobbies of their buildings to offer them free power chairs in exchange for allowing her to copy their Medicare and California identification cards. Judge Fischer found that Wells purposely misled beneficiaries into believing that she worked for Medicare or another government agency. Wells then sold the information she got for $400 to $500 per beneficiary. The individuals who bought the information fabricated prescriptions and medical documents that in turn were sold to fraudulent DME companies to submit false claims for power chairs and other DME, the DOJ said in a press release. One of those companies was Maydads Medical Supply of Arleta, Calif., which was owned by Wells’ co-defendant Sylvester ljewere, who was sentenced in October to a 46-month prison term for Medicare fraud. In imposing Wells’ sentence, Judge Fischer found that Wells was responsible for more than $1.2 million in false claims that were submitted to Medicare for approximately 200 beneficiaries. The case was brought as part of the Medicare Fraud Strike Force, now operating in nine cities, and supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California. Provider Newswire Praxair Acquisition Pays Off for Apria LAKE FOREST, Calif.—Last week Apria Healthcare posted net revenues of $536.7 million for the first quarter ended March 31 compared to $508.9 million for the same period in 2010. Revenue for the three months increased primarily due to home infusion revenues and its March acquisition of Praxair’s U.S. home care assets. The revenue increase was partially offset by the non-renewal or termination of, or changes to, certain payer contracts among other factors, the company said in a May 9 release. The provider reported a net loss for the quarter of $21 million. For 2011, Apria said it expects the Praxair addition to contribute approximately $85 to $95 million to its revenue. Its performance for the year will also be affected by increased selling, distribution and administrative costs related to the return of certain offshored billing and collections functions to its personnel in the United States “as we will no longer have the benefit of favorable offshore labor rates;” a full year impact of additional sales personnel that were only added for a portion of 2010; and an unfavorable impact related to Medicare competitive bidding. In addition, the company said, “the collection of accounts receivable is expected to remain one of our most significant challenges in 2011.” Liberator Sales Shoot Up 31 Percent STUART, Fla.—Liberator Medical announced last week that sales for its second fiscal quarter ended March 31 increased 31 percent to $12.64 million compared to $9.65 million for the three months ended March 31, 2010. The increase was primarily due to continued emphasis on its direct response advertising campaign, the company said in a May 13 release. Advertising expenses for the quarter were more than $2 million, with the majority of those expenses associated with the amortization of previously capitalized direct response advertising costs, the company said. Gross profit for the three months increased 27.3 percent to $7.97 million from $6.26 million in same period last year. “The second quarter of our fiscal year is typically a challenging quarter for us each year due to the annual renewal of our customers’ insurance coverage, primarily Medicare Part B coverage, and calendar year deductibles that must be met by the majority of our customers at the beginning of each calendar year,” said Mark Libratore, president and CEO. “In spite of these challenges, we were able to increase our sales for the twelfth consecutive quarter. The outlook for demand for our products and services is favorable, as there should be an increase in newly diagnosed patients requiring the medical supplies that we provide. We expect solid revenues growth over the next two quarters of fiscal year 2011 due to our aggressive advertising and marketing programs." Liberator’s revenue comes primarily from mail-order supply of general medical supplies, diabetes, urological, ostomy and mastectomy products. Rotech Improves Profitability in Q1 ORLANDO, Fla.—As of March 31, revenue-generating patients in Rotech’s core product lines of oxygen and CPAP grew 13.6 percent in this year’s first quarter compared to the first quarter of 2010, the company announced May 6. According to the provider’s Q1 financials, adjusted EBITDA for the three months increased 13 percent to $28.3 million from $25.2 million for the same period last year. Its ratio of net debt to last 12 months’ adjusted EBITDA decreased to 4 times compared to 4.8 times at March 31, 2010. The Florida-based provider, which operates about 425 locations in 48 states, also completed a refinancing of former senior subordinated notes due 2012 with the issuance of $290 million in aggregate principal amount of senior second lien notes. Along with an October 2010 offering of $230 million in senior secured notes to refinance its former payment-in-kind term loan facility, “we have now addressed our short-term debt maturities until 2015 and 2018,” the company reported. “In comparing first quarter of 2011 with that of 2010, we are pleased to report improvement in profitability with increases in gross profit and adjusted EBITDA percentages, as well as reductions in SG&A percentage,” said Rotech President and CEO Philip Carter. “This was in spite of a $3.7 million decline in Medicare reimbursements and other non-patient service revenue.” In Brief Warrior Games Begin Today; Invacare Donates to Storm Victims; More News in Brief COLORADO SPRINGS, Colo.—If you can’t catch the 2011 Warrior Games in person, don't worry. Select events will be broadcast live online at USParalympics.org/WarriorGames. Activities kick off today with the opening ceremony at 5 p.m. MT in Colorado Springs, Colo., where 220 wounded, ill and injured servicemen and women from the Army, Marine Corps, Navy/Coast Guard, Air Force and Special Operations will compete in seven sports. Online broadcasts of the competition will include the wheelchair basketball bronze and gold medal games on Friday, May 20, and the sitting volleyball bronze and gold medal games on Saturday, May 21. In addition, Versus will air a 2011 Warrior Games special on Saturday, June 18, at 7 p.m. ET. Invacare Donates to Storm Victims ELYRIA, Ohio—Invacare is donating equipment and supplies to the Friends of Disabled Adults and Children (FODAC) to assist relief efforts in the areas hardest hit by the recent severe storms and tornadoes in Alabama, Georgia, Mississippi and Tennessee. The total donation will top $65,000, including wheelchairs, crutches, mattresses and supplies such as adult incontinence items, gloves and hand sanitizer. FODAC will be providing ongoing assistance over the next weeks and months, including shipments of supplies. For information about the organization or to donate, visit www.fodac.org. CMS Releases Code Meeting Agenda BALTIMORE—CMS has released the agenda for its June 8 public meeting on new HCPCS code requests for DME. Each of the 10 agenda items includes an overview of the request and CMS’ preliminary coding decision. Included among the requests: Adding two new codes to the existing E0277 (powered pressure reducing air mattress) for distinctions based on width and weight capacity, and establishing a code for a new high efficiency/low impact wheelchair handrim. Final decisions will be announced in November. The meeting will run from 9 a.m. to 5 p.m. at CMS headquarters. See the full agenda, and get the link for meeting registration on the HCPCS website. Bruno Sells Power Tilt Cap Line OCONOMOWOC, Wis.—Lift maker Bruno Independent Livings Aids announced last week that it has sold its power tilt cap product, called Pow’r Topper, to Clock Conversions of Grand Rapids, Mich. The trademarked name is being retired. Under terms of the agreement, Clock acquired all existing inventory, names of key suppliers, demo equipment stands, manufacturing and assembly fixtures and engineering and application drawings. “We are happy that this product could continue to be available as a solution to protect the mobility device in pickup truck applications,” Andrew Bayer, Bruno automotive product manager, said in a release. "Bruno is continuing to streamline our product mix to focus on our core product offerings." According to the release, Clock anticipates being up and running by mid-June. Fastrack Announces Ownership Program PLAINVIEW, N.Y.—Fastrack Healthcare Systems unveiled a new ownership program last week that allows clients of its SaaS, or hosted model, to apply a large portion of their monthly hosting fees to the purchase price if they want to own the software license. “Most clients will own the software in approximately 42 months, however they can pay the difference at any time to obtain ownership,” Fastrack President Spencer Kay explained in a release. “Ownership potentially offers significant tax advantages and the software can be reflected as an asset of the business increasing its value. Paying hosting fees without potential ownership is like throwing money out the window.” To revisit this news anytime during the week, check www.HomeCareMag.com. We welcome your comments. Drop a line to HomeCare Editor-in-Chief Gail Walker at gwalker@homecaremag.com. ADVERTISEMENT |
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