Georgia Association of Medical Equipment Suppliers
NEWS & NOTES


April 27 | 2017

In this issue:

  1. DME Suppliers Still Exiting
  2. GAMES Spring Meeting
  3. Healthcare in the News
  4. Positive Changes at CMS
  5. Insurance Exchange in GA
  6. Important Industry Survey!
  7. Additional CMO Meet & Greets
  8. Save these dates!

GAMES Platinum Members!






GAMES Associate Members
Support the associate members who support GAMES. If your vendors aren't on the list, ask them why!


Platinum


Airgas Puritan Medical !
Christa Forrester
Mark Bradshaw



Drive DeVilbiss Healthcare
Joe Gessner
Steve Wakser




Philips Respironics
Susan Yenney
Kimberly Williamson



VGM Group
Gil McCall
Pat Aydelott


Gold

BREAS New
Todd Tyson

Brightree
Melinda Mahoney

CAIRE

Lanier Hogan

Fisher & Paykel
Gregg Stahl

Cryogenic Inventory Solutions
Anne Holcombe
Travis Caulk

Mediware
Michelle Caldwell

ResMed
Jamie Griffis

The Compliance Team, Inc.
Jack Haire
Sandra Canally

The MED Group
Ted Metcalf

Silver

Allegiance Group
Bruce Gehring

Barbara's Billing & Consulting
Barbara Penzien

Compass Health
Joe Toth

Linde Healthcare
Clay Stalnaker

McKesson Medical Surgical
Chip Wooten

Medical Specialties Distributors
Pat Burke

Medline

Brian Topchik

Medtronic
Chris Arapoff

Pharmacists Mutual Insurance
Hutton Madden


Bronze

Medtrade

Keving Gaffney

Pride Mobility Products
Steve Joyce

More than 40% of HME Suppliers Have Left Medicare Program Since July 2013

From AAHomecare, April 26, 2017

According to research AAHomecare had been performing using Medicare data, the number of traditional suppliers of home medical equipment to Medicare beneficiaries has dropped40.9% since July 2013. In addition, the number of unique locations (commonly referred to as "rooftops”) serving Medicare beneficiaries has declined by 38.7% during the same period. This drastic loss of suppliers is impacting Medicare beneficiaries’ access to critical home medical equipment and services, and the situation is sure to become even more dire without more sustainable reimbursement policy for HME.

This data paints a stark picture of the effects of the bidding program, which went into widespread effect in July 2013, on the HME infrastructure serving HME beneficiaries across the nation, in both bidding areas as well as rural locations. The losses have seemingly accelerated since the beginning of the application or bidding-derived pricing to non-bid areas in January 2016, with a 26.3% reduction in companies since then, as well as a 23.3% drop in total locations.

In comparison, total Medicare enrollees haveincreased by 8.6% from 2013 to 2016, according to data from CMS.

Details on state by state counts can be found here. The data is from theMedicare Supplier Directory,and is derived by using counts for companies and locations providing hospital beds, NPWT, support surfaces, wheelchairs & accessories, respiratory products, and oxygen.

AAHomecare plans to highlight this data in our advocacy efforts on Capitol Hill and at CMS, and encourages HME suppliers and other stakeholders to reference both national and state data in your contacts with legislators. See our accompanying Issue Brief on effects of the bidding program on the HME supplier infrastructure for additional perspective. 

Meet Amerigroup, CareSource, Wellcare, and PeachState at the GAMES 2017 Spring Meeting

Georgia Medicaid, DXC Technology, and the Medicaid CMO's will be in attendance at the GAMES Spring Meeting!

On Thursday, May 11, 2017, HME owners, operators, managers, as well as compliance officers and senior-level billing & reimbursement personnel are all invited to Atlanta for a
fast-paced, action-packed, information-filled day!

Soup To Nuts: Building Your Compliance Program so you can still eat your soup and not go nuts! CLICK HERE for agenda and registration information.

Your hosts for the day:

Laura Williard is the senior director of payer relations for the American Association for Homecare. She has served in the HME community for more than 24 years, in regulatory affairs, reimbursement, compliance, and contracting.

Wayne H. van Halem, AHFI, CFE is the founder and President of The van
Halem Group. A former auditor and national appeals director with Medicare, van Halem leads his team as they assist providers in navigating the complex issues related to audits, appeals, enrollment, and compliance.

CLICK HERE to learn more!

Healthcare in the News

These news clips were shared with GAMES by our state lobbyists, Southern Strategy Group:

Rural hospital in east Georgia to close, citing economic pressures

Another rural hospital is closing its doors in Georgia.

Medical cannabis studied for autistic kids
When Noa Shulman came home from school, her mother, Yaei, sat her down to eat, then spoon-fed her mashed sweet potatoes - mixed with cannabis oil.

Ideas and a sense of urgency permeate rural health care symposium
For many rural hospitals in Georgia, the threat of closure is constant.

Atlanta IT firm targeting health care fraud plots
Health care fraud is estimated to cost the nation at least $68 billion annually - with some estimates at $230 billion or more.

Prosecution of caregivers of at-risk adults is rare in Georgia
When Allison Mauldin pressed to prosecute a personal care home owner for murder, there wasn't much enthusiasm.

How fight over Obamacare could shut down the government
The fight over Obamacare's future is now threatening to shut down the federal government.

HCA to buy Memorial in a $710 million deal
HCA has agreed to acquire Memorial Health's financially struggling hospital in Savannah in a $710 million deal.


CMS Bends Its Will for DME

From Andrea Stark, MiraVista

Recent developments demonstrate the Medicare pendulum is finally swinging back towards a more balanced view. For the first time in years, DME providers are seeing positive changes in CMS policies that make sense.

For one, CMS has directed contractors to limit their scopein appeals to the original denial reason. That means no new surprises or issues to fight as a case moves up the ladder.

For another, CMS will now accept ordersfrom previous suppliers when a beneficiary simply changes suppliers. When a new supplier obtains documentation from a competitor, the customer won't have to undergo a new face-to-face or get a new order from their physician - just because they choose a different supplier. The significance of this change is far reaching and is welcome news for suppliers contemplating acquisition activity.

Also on the appeals front, CMS has started to pilota program where the QIC is authorized to overlook and mitigate simple errors that do not impact medical need for a product.

These are powerful changes and are indicative of a new day for HME providers!
Read more from Andrea!


Georgia Insurance Exchange: One in, One out

Insurer Centene commits to shaky ACA exchanges for 2018

From ABC News
One health insurer is eager to dive back into the Affordable Care Act's troubled insurance exchanges next year, even as competitors waver and President Donald Trump tweets doom about the law's future. READ MORE...

Anthem Threatens to Leave Health Exchanges if Subsidies Are Halted

From the New York Times
The parent company of Georgia's largest insurer warned it would consider leaving some federal health care marketplaces or raising its rates sharply if the government does not continue subsidies to help low-income people. READ MORE...


VGM reintroduces DME Supplier Impact Survey 

The Supplier Impact Survey has been created in an effort to provide legislators on Capitol Hill with real-world figures of the impacts on competitive bidding to suppliers and patients.

Data gathered from this survey will be used to strengthen the case on CapitolHill for reforms competitive bidding. We encourage suppliers in all geographic areas and all participation levels of competitive bidding to participate in the survey.

CLICK HERE to participate in the survey!


Additional Medicaid CMO Meet and Greets Scheduled!

This is an opportunity to learn about the CMOs, the provisions of the new CMO contracts, Transition of Care, and the upcoming Choice Change Period. For the new plan year beginning July 1, 2017, the CMOs serving Georgia will include Amerigroup, CareSource, Peach State Health Plan, and WellCare.

Rome
Friday, April 28, 2017
304 Turner McCall Blvd
Rome, Georgia 30929
8:00 a.m. - 1:30 p.m. (No Presentations. Table Talk only)

Toccoa
Friday, May 5, 2017
Stephens County Hospital
163 Hospital Drive
Toccoa, GA 30577
9:00 a.m. - 12:00 p.m.

Blairsville
Friday, May 12, 2017
Union General Hospital
35 Hospital Road
Blairsville, GA 30512
9:00 a.m. - 1:00 p.m.

Savannah
Monday, May 22, 2017
Memorial Health University Medical Center
4700 Waters Avenue
Savannah, GA 31404
8:00 a.m. - 1:30 p.m. 


Save These Dates!
April 26-27, 2017
Arlington, VA

Georgia Medicaid Fair

Tuesday, May 2
Cobb Energy Centre

GAMES Spring Meeting
"Soup To Nuts: Building Your Compliance Program so you can still eat your soup and not go nuts!"
Thursday, May 11, 2017
Atlanta, GA

AAHomecare Washington Legislative Conference
May 24 - 25, 2017
Washington, DC

VGM Heartland Conference 2017
June 12-15, 2017
Waterloo, IA

GAMES 2017 Annual Meeting
August 27 - 29, 2017
Jekyll