Issue link: https://read.dmtmag.com/i/52926
■ Analyst Dexter Braff says 2011 was a good year for home infusion deals, and 2012 looks just as good. See story this page. Bidding survey: Access denied ...................... 1 Update: ASP figures for neb-meds .................. 25 Program helps pharmacies master merchandising. . . . . 25 Focus on the Future tradheshow set for March ........ 26 Rx and Specialty Providers WWW.HMENEWS.COM / FEBRUARY 2012 / HME NEWS 25 BRIEFS NHIA comments on proposed rule WASHINGTON – CMS should require the DME MACs to create consistent policies regarding ongoing medical necessity, and require physicians to respond in a timely manner to suppliers' requests for informa- tion, stated the National Home Infusion Association in a Dec. 27 letter to Acting Administrator Marilyn Tavenner. The com- ments were submitted in response to the proposed rule, "Medicare and Medicaid Program; Regulatory Provisions to Pro- mote Program Efficiency, Transparency, and Burden Reduction." Bi-level devices not appropriate for OSA WASHINGTON – Recovery auditors have found that Medicare has been paying for a bi-level device (E0471) when the primary diagnosis was obstructive sleep apnea (OSA). In a December message Noridian, the Jurisdiction D DME MAC, states that, according to the local coverage determina- tion for PAP, E0471 is not reasonable and necessary if the primary diagnosis is OSA and will be denied by Medicare. Providers are advised to check the Respiratory As- sist Devices LCD (l11493) for information on coverage, coding and documentation for the use of E0470 and E0471 for diag- noses other than OSA. NGS: Include narrative with diabetes strip claims WASHINGTON – Providers who submit claims for 10 or more test strips (A4253KS) for a non-insulin treated diabetic beneficiary will need to include a narrative to be paid, ac- cording to a message in December from National Government Services, the Juris- diction B DME MAC. Effective Feb. 1, pro- viders must include the acronym UOS, for unit of service, followed by the actual num- ber of units of service submitted. Claims that do not contain this information will be returned as not able to be processed. NHIA publishes annual infusion code guide ALEXANDRIA, Va. – The National Home In- fusion Association (NHIA) on Dec. 21 re- leased the 2012 version of the "NHIA Na- tional Coding Standard for Home Infusion Claims under HIPAA." The annual publica- tion of procedures and claims examples is part of an effort to advance standardiza- tion of claim transactions and coding for home infusion services. It is available free of charge at www.nhia.org. Graymark acquires another sleep lab OKLAHOMA CITY – Graymark Healthcare has acquired a majority interest in Village Sleep Center in Plano, Texas, it was announced Dec 15. Graymark now operates a total of 100 sleep labs, including standalone facili- ties and hospital-based labs, nationwide. Graymark offers diagnostic and sleep ther- apy services. M&A: Home infusion market 'alive and well' BY THERESA FLAHERTY, Managing Editor YARMOUTH, Maine – The appetite for home infu- sion companies remained strong in 2011, tempered only by a lack of companies on the market, say industry analysts. "There's still very strong demand from both the strategic and the private equity- backed (buyers)," said Mike Patton, man- aging director for Boston-based Provident Healthcare Partners. "I think the biggest issue at this point is the availability of sizable add- on acquisitions due to consolidation over the last five years." There were a healthy 12 deals during the first two quarters of 2011, followed by only one deal in the third quarter, says Dex- ter Braff, president of Pittsburgh-based The Braff Group. That doesn't necessarily mean the market is on a downward trend, he said. "We've already eclipsed last year's total and equaled that of 2009," said Braff. "The reality is, home infusion is alive and well." Alive and well, but on a smaller scale than in the past, say analysts. "We have seen a number of small acquisi- tions over the past 12 months," said Greg Wappett, senior analyst for Provident Health- care Partners. "But anything sizable, anything over $10 million, has been lacking in the market over the last couple of years." One company that's been making strategic buys: Cincinnati-based CarePoint Partners, which acquired five companies in 2011. Still, that's a far cry from the deals of a few years ago, when Walgreens acquired Option- Care for $850 million and Apria acquired Coram for $350 million. "There was a little bit of a frenzy during that period and it fueled a mini-bubble in valuations," said Braff. Analysts say they expect home infusion to remain an attractive buy. The push, under healthcare reform, to less costly care only Demand is high, but opportunity is low, say analysts. underscores the value of home infusion, say analysts "It gets people out of the institutions, and there's a push toward incentivizing providers to get that service out there," said Wappett. "That's always going to be of interest to the healthcare system in general." HME Budesonide: Competing generics on the horizon BY THERESA FLAHERTY, Managing Editor BALTIMORE – The needle barely moved on the average sales price (ASP) figures for nebulizer medications, according to the latest figures, released in December. The only neb-med to show any significant change was budesonide (J7626), which rose 23.8 cents to $4.63 per dose. While an increase in reimbursment is always welcome, there's still not a lot of margin on the drug, says provider Sam Jarzcynski, who stocked up in advance of an October price increase. "We were able to buy enough to get us through," said Jarczynski, president of St. Petersburg, Fla.-based RxStat. "It's a toss up whether that drug is going to be avail- able to patients before the new generics come out and make the price go down." Whether several competing gener- ics of budesonide hit the market some- time in 2012, as is anticipated, depends on whether the generics get through the BUDESONIDE SEE PAGE 27 THE YEAR IN SLEEP iPads, home sleep tests and a mea culpa BY THERESA FLAHERTY, Managing Editor THIS SHELVING UNIT, designed by NCPA's Gabe Trahan, helps a small pharmacy make the most of limited display space. Does your pharmacy have curb appeal? A new program seeks to help independents revamp their front-of-store merchandising BY THERESA FLAHERTY, Managing Editor ALEXANDRIA, Va. – When it comes to looking after your bottom line, it pays to look after your front end, says the National Community Pharmacists Association (NCPA). In November, the association launched "Front-End Over- haul…More Traffic, More Profits!", a program to help community pharmacy owners revamp their front-of-store merchandising to increase their curb appeal. "Revenue streams are drying up," said Gabe Trahan, senior director of marketing and store operations for NCPA. "Pharmacists APPEAL PAGE 27 Consider the cane. See page 27 D ESPITE THE plethora of news across the special- ty provider spectrum in 2011, it was a real eye opener to learn that the year's top stories all dealt with sleep. But that's about all they had in common. From there, the stories diverge, high- lighting new ideas, new markets and new competition. The five most read stories from www.hmenews.com: 4 CMS admits RAC got it wrong 4 AASM shifts sleep strategy 4 Proposed change could add teeth to CPAP policy 4 Providers eye home sleep test market 4 Rules of engagement: CPAP provider goes high tech In the top story, CPAP provid- ers found themselves on the right side of the audit tracks in Febru- ary when CMS said it would halt CPAP audits in Jurisdiction D after learning that auditors were misinterpreting policy and trying to recoup money. CMS offered a mea culpa and told providers refunds were possible. CPAP providers were also busy keeping an eye on some potential new competition. In September, the American Academy of Sleep Medicine (AASM) proposed cre- ating a pilot program that would allow sleep centers to provide CPAP equipment to Medicare beneficiaries—a big no-no for CPAP providers.Providers under- standably feel threatened, and, toward year's end, several told HME News that the industry needs to pull together and craft a unified response. Providers continued in 2011 to look for ways to grow. Although home sleep testing is still a bit of a wild west, many providers reported they were actively look- ing at partnering with third-par- ty payers and testing facilities to do what CPAP providers do best: manage patient compliance, SLEEP SEE PAGE 26