Congressman Jim Matheson visits UTMED to discuss Competitive Bidding and Audit Woes

Left to right: Kurt Walker, Tom Dye, Congressman Jim Matheson, Jay Broadbent, Brent Gardner

On Tuesday this week, UTMED arranged for a visit from Congressman Jim Matheson to meet with members of the UTMED Board. UTMED Vice President Jay Broadbent from Alpine Home Medical and board members Kurt Walker from Mountain Valley Home Medical and Tom Dye from Oxygen-for-You were in attendance. Congressman Matheson has been very supportive of UTMED in signing on as a cosponsor of HR 1041 and clearly sees competitive bidding as ineffective as a cost saving tactic by the congress. He was also very interested in receiving examples from UTMED members of unreasonable audit requirements such as refusal to pay due to physician signatures outside the lines, etc. As a result, he is going to seek hearings on CMS audit practices and will use the examples to disclose their burdens on local DME companies.

Article written by Brent Gardner, Executive Director of UTMED

AAHomecare Supports Key Anti-Fraud Bill Introduced in House

Friday, November 11, 2011

The American Association for Homecare (AAHomecare) is pleased that Representative Peter Roskam (R-Ill.) introduced an important bill yesterday designed to reduce fraud and improper payments in Medicare.

The Fighting Fraud and Abuse to Save Taxpayer Dollars Act, or FAST Act, H.R. 3399, would strengthen Medicare by shifting Medicare's "pay-and-chase" payment system to one that is modeled after credit card industry fraud-prevention tactics, utilizing predictive modeling technology to prevent paying fraudulent Medicare claims. The legislation also contains a provision, supported by AAHomecare, which would require an electronic prior authorization process for standard power wheelchairs in Medicare. This provision requires physicians to use a clinical medical necessity template to document the medical need for a power wheelchair. The Association believes that this physician template is a critical tool needed to reduce improper payments due to documentation errors.

AAHomecare has long fought against Medicare fraud. The Association has worked with Congress and the Administration to implement a number of key components of its 13 point anti-fraud plan. Visit www.aahomecare.org/stopfraud to see the plan. Last year, AAHomecare supported H.R. 5546, introduced by Rep. Roskam, which would have improved the tools and resources available to prevent fraud and abuse in Medicare through the use of predictive modeling technologies.

The Association welcomes the opportunity to work with Rep. Roskam on this important bill as it moves through the legislative process.

Article written by AAHomecare.

CMS defines durability, industry awaits CBO score

CMS defines durability, industry awaits CBO score

By Theresa Flaherty, Managing Editor - 11.04.2011

WASHINGTON - CMS last week issued final rules related to durable medical equipment, including a finalized definition of "durability." CMS originally proposed the defining "durability" as meeting a three-year minimum lifetime standard in the July 8 Federal Register. At the time, stakeholders said they were unsure of what CMS sought to accomplish. They're still unsure. "We're still trying to sort it out," said Jay Witter, senior director of government relations for AAHomecare. "The proposed rule was kind of vague, so our manufacturers didn't understand how it would affect their equipment." Initial concerns included whether redesigned equipment--saying improving the technology on an existing wheelchair--meant that it would have to meet the new criteria, and what the process for meeting that criteria is. "It's still not clear what the process is," said Witter, who was still analyzing the rule last week. The other rule finalized provisions related to competitive bidding that were included in an interim final rule released in January 2009, and the Medicare Improvements to Patients and Providers Act of 2008. "They tied up some loose ends, but there was no new policy," said Cara Bachenheimer, senior vice president of government affairs for Invacare. "The more disconcerting thing was that CMS used it as another opportunity to talk about how great Round 1 was." Meanwhile, the industry continues to build consensus for a market pricing program (MPP) as an alternative to competitive bidding. "We're trying to get it scored by the Congressional Budget Office," said Tyler Wilson, AAHomecare's president and CEO. "Then we'll know whether we've met the $20 billion in savings, or whether we need to find some additional savings. There's a lot at play and we have limited opportunity for conversations (with lawmakers)." Concerns have been raised that pushing forward with MPP would mean throwing Round 1 providers under the proverbial bus. While no one wants to see that happen, lawmakers have said they won't support MPP if it includes changes to Round 1. "It is a political reality that we can't get everything we want," said Wayne Stanfield, executive director of NAIMES. "Sometimes its prudent not to fight for everything, but take what you can get, with hopes of changing the impact on Round 1 afterward." Sean Schwinghammer, president of the Florida Association of Home Care Suppliers has said he's disappointed that the industry is moving forward without any relief for Round 1, but says he is supportive of MPP. "We are united in MPP and think it's a good idea for Round 2," he said. "But, to be clear, its ludicrous to use Round 1 as the justification for altering Round 2, and leaving Round 1 to exists." Article written by HME News.

Alpine awarded with title of "Best HME Provider" by the HME Excellence committee.

This year Alpine is pleased to hold the title of “Best HME Provider” presented by the HME Excellence committee (HME News). The committee made their decision based on a variety of qualifications, including average annual rate of sales growth in the past two years, average pre-tax profit margin over the last three years, memberships, leadership positions, non-profit community involvement, and more. The award was announced at this year’s MedTrade conference, during “Power of Funding.”

HME News Article:

Meet Alpine Home Medical Equipment, winner of the 2011 HME Excellence Awards for best HME provider. President Jay Broadbent says he’s had his share of successes--and failures--along the way.

Broadbent will share his failures, too. Like the time he signed up his team to exhibit at the Utah State Fair.

“It was 10 days straight, and we had to man it from 9 a.m. to 10 p.m.,” he recalls. “We were pooped. We didn’t get a single sale from that thing.”

His willingness to risk failure originates in Broadbent’s business philosophy: “If you’re not growing, you’re dying.”

That focus on growth has paid off--Broadbent estimates that Alpine Home Medical is growing about 40% a year and they’ve just secured a large state contract.

“It’s a big deal for us as a company,” he says. “We’re adding four more branches and close to 20 people to take on this contract.”

That’s in addition to Alpine Home Medical’s current 100 employees in seven branches throughout Utah. The 14-year-old full-service provider also has a retail store in most of its branches.

The company uses open book management, allowing all employees to look up its P&L statement at any time.

“It’s where can we do better? How can we reduce costs?” says Broadbent. I’m always amazed at the (providers) who don’t know their business, who don’t break down their financials every month and look at their strengths and weaknesses.”

Alpine Home Medical also emphasizes their role as a community partner, which is embodied by the comany’s B In Motion Foundation. It sponsors a yearly bicycle race to raise money to give wheelchairs to uninsured patients.

“It ties us back to our community,” Broadbent says. “We’re homegrown and that rings true in our market.” -HME News

Durable Medical Equipment Is 1.4% of Total Medicare Spending--and Falling

The Honorable Gene L. Dodaro, Letter to Congress

The Honorable Gene L. Dodaro

Comptroller General of the United States

441 G Street NW

Room 7100

Washington, DC 20548

Re: Medicare National Competitive Bidding

Dear General Dodaro:

We are writing to request an immediate and comprehensive review of the Medicare National

Competitive Bidding (NCB) program for durable medical equipment (DME) begun by the

Centers for Medicare and Medicaid Services (CMS) with Round One on January 1, 2011.

In your review and report we ask that you consider and answer the following questions with

regard to Round One of NCB:

1. What is the impact on beneficiary access to quality and timely services?

2. What is the impact on jobs generally?

3. What is the impact on job loss for small DME businesses?

4. Should winning bidders be required to deliver products and services at their bid prices?

Should retail pharmacies be included in NCB?

5. Can NCB and the Affordable Care Act be synchronized?

6. Is NCB consistent with the demonstration projects conducted by Health Care Financing

Agency (HCFA), now CMS, in FL?

We further request that you consult with all interested parties and stakeholders, including but not limited to CMS, State Health Departments, beneficiaries, DME dealers, DME manufacturers, the Institute of Medicine, and the Bureau of Labor Statistics.

We understand the usual practice to share your report with the affected agency, in this case CMS, but ask that you not change your report based on CMS comments. Please deliver your report and CMS comments to this Committee by February 1, 2012.

Thank you for your attention to this matter.

44(110 1 Rogers Denny Rehberg Chairman, Chairman, Appropriations Committee Subcommittee on Labor, Health and Human Services, Education and Related Agencies

Program Can Reduce Older Adult Falls by 31%

Program Can Reduce Older Adult Falls by 31%

(Salt Lake City, UT) – Every day, an average of eight Utahns age 65 and older are hospitalized for injuries due to a fall. In 2010, there were 3,129 fall-related hospitalizations among older Utahns, costing more than $85 million in treatment charges. Falls were the leading cause of injury-related death among older adults in Utah. The Utah Department of Health (UDOH) wants to remind everyone that injuries from falls are largely preventable.

“Falls are not a normal part of aging,” said Trisha Keller, Program Manager for the UDOH Violence and Injury Prevention Program. “Most falls are preventable if we can teach older adults what hazards to remove in their homes and help them increase their strength and balance.”

Stepping On is a 7-week program now being implemented by local health departments across the state. The program focuses on empowering older adults to engage in health behaviors that reduce the risk of falling, such as removing tripping hazards in their homes and doing simple exercises to build strength and improve balance. And national research shows the program works: falls among study participants were reduced by 31 percent.

Seventy-five-year-old John “Charley” Jones joined a Stepping On class last year after noticing his balance wasn’t as good as it had been. “I tended to shuffle when I walked and thought I better try to preserve or improve on what I have so it didn’t get worse,” Jones said. “I would encourage others to take the class. The instructors made everyone feel comfortable and I never felt like an old, decrepit person there. The classes were not only informative and helpful, they were fun, too,” he added.

“Our goal is to help our citizens remain independent and healthy,” said Karen Jensen, a Stepping On instructor at the Utah County Health Department. “Even minor falls can have a dramatic impact on a person’s well-being and sense of safety.”

Several new Stepping On classes will begin in September and October. The classes are free and will be held at:

• Orem Friendship Center (93 North 400 East, Orem) every Friday beginning September 23, 2011 until November 4, 2011 from 9:30 a.m. to 11:30 a.m. To register for the class, participants must be a member of the center. Call 801-229-7111.

• Springville Senior Center (65 East 200 South, Springville) every Friday beginning September 23, 2011 until November 4, 2011 from 1:00 p.m. to 3:00 p.m. To register for the class, call 801-851-7095.

• North Davis Senior Activity Center (42 South State Street, Clearfield) every Thursday beginning October 13, 2011 until December 1, 2011 (except on Thanksgiving Day) from 9:00 a.m. to 11:00 a.m. To register for the class, call 801-525-5076.

• Wasatch County Senior Citizens Building (465 East 1200 South, Heber City) every Tuesday beginning October 11, 2011 until November 22, 2011 from 9:30 a.m. to 11:30 a.m. To register for the class, call 435-657-3312.

The UDOH recommends four basic steps to reduce the risk of falls:

• Begin a regular exercise program. Exercise improves strength and balance,as well as coordination.

• Have your health care provider review your medicines. Some medicines or combinations of medicines can make you sleepy or dizzy and cause you to fall.

• Have your vision checked. Have your eyes checked by an eye doctor at least once a year. Poor vision can increase your chances of falling.

• Make your home safer. Remove tripping hazards like throw rugs and clutter in walkways as well as books and papers from stairs. Install grab bars next to your toilet and shower.

Utah will join 43 other states in recognizing September 23, 2011 as Falls Prevention Awareness Day. For more information about falls or the Stepping On program, visithttp://health.utah.gov/vipp/olderAdults/overview.html.

Media Contact:

Jenny Johnson

Violence & Injury Prevention Program

(o) 801-538-9416 (m) 801-298-1569