We're looking for the Provider of the Year! - Richmar
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We’re looking for the
Provider of the Year!
Accepting applications for the HME Excellence Awards
We’re looking for providers who excel in customer service, value their employees,
generate solid financials and give back to their communities. If that’s you, apply for
the Provider of the Year Award! It’s quick and easy to apply online.
You could win an HME Databank subscription ($995 value). All applicants will be
entered into a drawing for a free one-year subscription to the HME Databank.
Bonus: The winner gets two FREE
registrations to the 2019 HME News
Business Summit, September 22-24
in Cleveland! Business Summit
Application deadline: June 6
www.hmeexcellenceawards.com
■ Inogen capped off a ■ Product Spotlight: Check out the latest HME ■ Do CVS’s
HealthHUBs
‘year of investment’ in in diabetes products including the GlucoCard
Shine family of glucometers from ARKRAY
NEWS concern you? See
results on page
2018, says CEO Scott
Wilkinson. See page 24. USA. See page 21. POLL 26.
VOLUME 25 — NUMBER 4
APRIL 2019 $7.00
T H E B U S I N E S S N E W S P A P E R F O R H O M E M E D I C A L E Q U I P M E N T P R O V I D E R S
NEWS
■ Stakeholders work to ready legislation.
PAGE 3
Round 2021 begins to take shape
■ Doc lookup enters test phase. PAGE 3
■ N.H. providers seek MCO changes.
Timeline, new product categories, including vents, vex industry stakeholders
PAGE 4
The agency on March 7 begin in May and the bid window head of the government affairs
BY THERESA FLAHERTY, Managing Editor
announced plans for the next set to open in June. practice at Brown & Fortunato.
WASHINGTON – CMS has set an round of the program, including “That’s an incredibly short “I am concerned about the lack
MEDTRADE “aggressive” timeline for HME new product categories, and out- timeframe given the significant of time to make sure people get
■ Medtrade Spring Show
providers to gear up for Round lined its projected schedule, with difference in the lead-item pricing comfortable with this.”
Director Kevin Gaffney
says attendees can’t 2021 of competitive bidding. education and registration set to model,” said Cara Bachenheimer, R O U N D 2 0 2 1 S E E PA G E 6
CVS tests CPAP supplies
afford to look back.
PAGE 8
HOME INFUSION
NHIA sues
at HealthHUBs in Houston
DEPARTMENTS
HHS over
PROVIDERS
■ It’s too early to tell impact of gap period.
PAGE 13
CVS IS PILOT-
payments
■ Providers cultivate customer reviews. THERESA FLAHERTY, Managing Editor
PAGE 13 ING HEALTH-
VS’S PLANS to push fur- HUBS as a way
MOBILITY
■ CRT conference mixes it up. PAGE 17
■ Rehab Medical buys OMS. PAGE 17
C ther into the HME market
don’t faze providers, who
say they’ve seen what happens
to increase its
healthcare ser-
vices, including
BY THERESA FLAHERTY, Managing Editor
RX & SPECIALTY PROVIDERS when other outside companies screening for WASHINGTON – Stakeholders say
■ Stakeholders seek to fast track two try to muscle in. sleep apnea, and they were left with no other
bills. PAGE 19 “I don’t see it as a lot of com- expand its DME options when they filed a law-
■ Viemed ready to fuel growth. PAGE 19 petition for brick-and-mortar offerings. suit against the U.S. Department
VENDORS DMEs,” said Mike Kuller, owner of Health and Human Services
■ Invacare re-evaluates business of Allstar Medical Supply in Wal- In February, CVS announced apnea, and expand its DME offer- over its transitional payment for
segments. PAGE 24 nut Creek, Calif. “It’s an interest- it would pilot three HealthHUBs ings to include CPAP masks and home infusion services.
■ PurWell takes VirtuOx approach to CBD ing concept, but in terms of hav- in the Houston area. The loca- accessories. “We have been fighting this at
market. PAGE 24
ing an impact on us or healthcare tions would devote more space HME providers are able to help every level and made no prog-
as a whole, it’s kind of a drop in to healthcare services, including customers with their products in ress,” said Sharon Pearce, vice
WWW.HMENEWS.COM
the bucket.” screening for diabetes and sleep H E A LT H H U B S S E E PA G E 1 4 president of government affairs
for the National Home Infusion
Belluscura Technology permeates Association. “We really tried
to find a resolution, but their
thinking and position hasn’t
readies POC annual symposium moved one inch from the final
rule.”
The final rule, published in
BY LIZ BEAULIEU, Editor
November 2018, implemented
BY LIZ BEAULIEU, Editor
PLANO, Texas – Belluscura, a U.K. the transitional payments on
company that licenses and devel- ORLANDO, Fla. – National Seat- Jan. 1, 2019, through Dec. 31,
ops proprietary healthcare tech- ing & Mobility automated its 2020, to address a payment gap
nologies, plans to launch a por- benefits and eligibility process created by the 21st Century
table oxygen concentrator named last year, helping to increase its Cures Act. However, the rule
the X-PLO2R in the U.S. market funding efficiency by 15% and limits reimbursement for pro-
in the back half of this year. reduce its funding cycle time fessional services to only those
In March, Belluscura, which is by 10% in 2018, says CEO Bill days a “skilled professional is in
headquartered in Plano, Texas, Mixon. the home.”
was in the middle of trying to This new process was among When Congress passed the
raise funds to complete the regu- the highlights at the company’s THE KEYNOTE SPEAKER Cures Act and the transitional
latory clearance process with the annual symposium, Feb. 7-10 in for NSM’s annual event was payment, it was clear on how
U.S. Food and Drug Administra- Orlando, Fla. motivational speaker and gold home infusion was supposed to
tion and launch the unit. “In the past, the process medalist Mike Schlappi, author be paid for, says Pearce.
“We’ve already raised $6 has been, like for most other of “Shot Happens: I Got Shot, “Payment is to be made per
B EL LUSCURA S EE PA G E 2 5 N S M S Y M POS I U M S EE PA G E 2 5 What’s Your Problem.” N H I A VS H H S S E E PA G E 2 0
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■ Karyn Estrella at HOMES Stakeholders work to line up legislation. . . . . . . . . . . . . . . 3
and providers in New Newspoll: Providers look to learn at Medtrade Spring . . . 3
News
Hampshire are taking a
proactive approach to
Q&A: David Chandler, AAH’s newest hire . . . . . . . . . . . . . . 3
MCOs. See story page 4. Health spending to reach $6 trillion by 2027. . . . . . . . . . . . 6
WWW.hMeNeWS.COM / APRiL 2019 / hMe NeWS 3
Briefs Doc
Billing reminders: RTLT Stakeholders work
modifiers, DWOs, ABNs
WATERLOO, Iowa – HCPCS codes that re-
quire the RTLT modifiers need to be on to line up legislation lookup
two separate claim lines effective for dates
of service beginning March 1, VGM has
alerted providers. Currently, it’s acceptable
to use one claim line with two units of ser-
Recommendations on next round
of bidding also on spring agenda
reimbursement.
“AAHomecare has talked with CMS numerous
testing
begins
times about the o2 budget neutrality issue, but the
vice with RTLT…VGM has also reminded agency has indicated it does not have the statutory
providers that they can complete detailed By Liz BeauLieu, editor
authority to change it,” Witter said. “This means
written orders for CPAP accessories, with WASHINGTON – AAHomecare is working to get a bill that federal legislation will be
the exception of the physician’s signature to provide additional relief from Medicare’s com- necessary.”
and signature date. VGM says that DWOs By Theresa FLaherTy, Managing editor
petitive bidding program introduced in the House While it works to have hard
are not required prior to delivery but are of Representatives and the Senate in time for the asks for its legislative confer- WASHINGTON – Medicare’s docu-
required prior to submitting claims for re- Washington Legislative Conference in May. ence May 22-23, AAHomecare mentation lookup service is
imbursement. “Best practice is to obtain “We’re working with House and Senate cham- has also been funneling rec- moving ahead into various test-
all the necessary information prior to de- pions on legislation that would provide addition- ommendations to CMS on the ing phases, according to CMS
livery to make for a smoother transaction,” al relief to rural, non-CB and non-rural/non-CB next round of bidding, includ- and other officials on a recent
it says…Do providers need ABNs for non- areas,” said Jay Witter, senior vice president of ing product categories on Jan. Special open Door forum.
Bachenheimer
assigned claims? The short answer is no, public policy for the association. 17 and on bidder capacity eval- The Documentation Require-
VGM has advised providers. The reason In a final rule published late last year, CMS uations on feb. 7. ment Lookup Service, launched
for denial on the ABN can’t state, “Claim is agreed to extend 50/50 blended reimbursement “In addition to increased in 2018, will pull together
non-assigned because the reimbursement rates in rural areas through Dec. 31, 2020, but transparency, the overarch- existing requirements that are
is lower than my cost.” not for all non-bid areas. It also neglected to apply ing message was, you should currently scattered among vari-
CPI adjustments to rates in bid areas retroactively establish capacity based on a ous manuals, national Cover-
CMS appoints data chief
from 2008-12. bidder’s historical capacity, not age Determinations and Local
WASHINGTON – CMS has appointed Dr. Mark
Witter declined to provide specifics on the bill projected capacity,” said Cara Coverage Determinations, and
Roche as chief healthcare informatics offi-
but said, “We’ve had positive meetings with both Bachenheimer, head of the present them in a machine-
cer in the Office of the Administrator. Roche
the House and Senate folks. They understand the Jay Witter government affairs practice at readable format within the elec-
has more than 16 years of experience work-
need for additional relief.” Brown & fortunato. tronic health record, according
ing in government, academic and indus-
AAHomecare is also working to get a bill Stakeholders have also recommendations on to CMS. The idea is to reduce
try sectors on initiatives such as national
introduced to address the application of a “bud- bona fide bids, including that CMS include non- the burden on physicians,
eHealth strategy, data modeling and se-
get neutrality offset” to home oxygen therapy. lead items, not just lead items, in its verification reduce improper payments
mantic interoperability, according to an ar-
Stakeholders argue this creates a “double dip” in process. hme and appeals, and improve the
ticle on healtcareinnovation.com. In his new
L O O k u p s ee pa g e 6
role, Roche will be responsible for helping
to formulate and implement clinical and
technical aspects of CMS’s interoperability
strategy and MyHealthEData initiative. Providers put on their learning caps Twenty per- pricing to oper- operations to help reduce their
CMS schedules By Theresa FLaherTy, Managing editor
coding meeting
BALTIMORE, Md. – CMS will hold the annual
O hMe
n e - q u A RT e R
the respondents to a
of
cent of respon-
dents cite a
new track, “The
ating during the
“gap” period,
as the industry
expenses.
“(I am interested in learning
about) the best systems and
Healthcare Common Procedure Coding
System (HCPCS) Coding and Payment
recent HMe newspoll
say they’re most interested in
new Competi-
tive Bidding,” as NEWS seeks to reshape
the next round of
products for implementing a
non-delivery oxygen model,”
POLL
Determinations public meeting for DME- learning about retail and cash their top pick for bidding, hopeful- wrote one respondent.
POS on June 11-12, 2019. The meeting sales at the upcoming Medtrade learning. CMS in ly for the better. of course, the conference
provides an opportunity to discuss coding Spring conference and expo. 2018 announced “How is the isn’t the only place to learn
and payment determinations for all new re- Sessions being offered in it was pausing the program for industry preparing to right the at Medtrade Spring. There’s
quests for revisions to the HCPCPS codes. this track include “Retail: Tips up to two years to overhaul it. ship?” wrote one respondent. also the expo, which will fea-
Interested parties can make oral presen- from the Grocery Industry” and Well-known experts will lead fifteen percent of respon- ture 160 exhibitors this year,
tations or submit written comments. Reg- “Retail employees for the Long sessions that cover everything dents say they’re most interest- say show organizers, and
istration information will be available at a Haul.” from the final rule to lead-item ed in learning about business N E WS pO L L s e e pag e 6
later date.
People: Board
appointments, new chair
Q&A with dAvid chAndler
AAHomecare has appointed three new
members to its board of directors: Mi-
chelle Templin, vice president of legisla-
MCOs: ‘We need to transform school of thought’ Council; and a member of AAHomecare’s edge will be really important to our efforts.”
tive affairs and business development for By Liz BeauLieu, editor
Regulatory Council and State Here are four things to know about
Managed Health Care Associates; Jeff WASHINGTON – AAHomecare will grow its Leaders Council. He also Chandler:
Bowman, vice president of home medi- payer relations team in April to include serves on the north Caroli- he’S ReADy TO geT TO WORk
cal equipment for McKesson Medical- David Chandler as its director of payer na Board of Pharmacy/DMe “I’m looking forward to continuing Lau-
Surgical; and Todd Walling, senior vice relations. Subcommittee. ra’s efforts, partnering with state associa-
president of sales for Permobil, Business Chandler is director of reimbursement “He’s done great things for tions in lobbying Medicaid programs to
Region Americas…HOMES has named and government affairs for Liberty Medi- this industry already,” said protect reimbursement,” he said. “That
Sean Andrews as its new Maine State cal Specialties based in Whiteville, n.C.; Laura Williard, vice presi- effort has been very successful, but there
Chair. Andrews has worked at Bedard treasurer of the Atlantic Coast Medical dent of payer relations at are still some states out there that need
Medical in Lewiston for 11 years, includ- David Chandler
equipment Services Association; chairman AAHomecare. “Having his help. We’ll also be working to protect
ing three as director of HME operations. of the Medicare Jurisdiction C Advisory provider knowledge and industry knowl- c H A N dL ER s e e pag e 6
4 State News WWW.hMeNeWS.COM / APRiL 2019 / hMe NeWS
new hAmpshire Briefs
has released budget recommendations for
2020 and 2021 that include reimbursement
cuts for DME, MAMES reports. Walz proposes
Providers seek changes MCO bill clears
kentucky house
changing “the medical assistance reimburse-
ment formula for durable medical equipment
that is also covered by Medicare to pay equiv-
to MCO contracts FRANkFORT, ky. – A bill that would hold man- alent to the Medicare rate…This would reduce
aged care organizations more accountable payment for DME starting in FY 2019 and re-
passed the Kentucky House of Representa- duce the value of recoveries in the forecast
tives on Feb. 21 by 100-0, VGM reports. The starting in FY 2021.” Walz also proposes sim-
Primary concern: For-profit Chief among the concerns: a sole-source bill, H.B. 224, would ensure that DME provid- plifying reimbursement for products that don’t
ers are paid at the rate set by the Kentucky have a Medicare rate.
that is part of Centene Corp. contract that nHHf has with Medline for
Medicaid program and would ensure that
incontinence supplies, and a new fee sched- Legislature in Tennessee
ule that pays roughly 70% of non-rural when they receive prior authorizations their
By Theresa FLaherTy, Managing editor
Medicare rates. claims can’t be denied for “lack of medical recognizes complex rehab
cONcORd, N.H. – HoMeS is trying to get out Also a concern: a requirement that claims necessity.” Stakeholders, including members NASHVILLE, Tenn. – The Tennessee General As-
ahead of the next round of Medicaid man- for miscellaneous codes be submitted with of KMESA, had been lobbying hard to move sembly has passed a bill that recognizes com-
aged care contracts in new Hampshire and invoices containing MSRP information. If the bill. It now moves to the Senate. The bill plex rehab as a separate benefit category.
incorporate protections for HMe providers. they don’t, providers will only be paid cost would also require that specialty items, such The state’s House of Representatives passed
In february, HoMeS members met with plus 10%, says Karyn estrella, HoMeS as parts to customize wheelchairs, are reim- H.B. 0647 94-0 on March 7, then the Sen-
Sen. Tom Sherman, a Democrat who chairs president and Ceo. bursed at the manufacturer’s suggested retail ate substituted that bill with S.B. 0632 and
the new Hampshire Health and Human “Invoices don’t have MSRP informa- price minus 15% or an invoice cost plus 20% passed it 30-0 on March 11. The bill requires
Services committee that oversees the Med- tion—they are essentially asking for some- when there is no MSRP; require that, should the commissioner, under the Long-Term Care
icaid program, to discuss ongoing concerns thing that doesn’t exist,” she said. a patient transfer from one MCO to another, Community Choices Act, to recognize com-
with one contractor in particular—new estrella has begun gathering information services that are currently being provided un- plex rehabilitation technology as a separate
Hampshire Healthy families, a for-profit from providers about lost revenues and lay- der a PA will be honored by the new MCO; benefit category for the purposes of any pro-
that is part of Centene Corp. offs in response to a request from Sherman. and require MCOs to cover, at a minimum, the posed budget or other public documents; and
“We are trying to be proactive on this “He’s very concerned about the impact same quantities of supplies covered under the defines complex rehabilitation technology as
next round,” said Tamme Dustin, president on local providers and is interested in draft- Medicaid fee schedule including Group 3, 4 and 5 power wheelchairs
and Ceo of Herron & Smith in Hooksett. ing legislation, whether that can be imple- and certain manual wheelchairs. The bill now
“How is the state going to protect us as mented before these next contracts go into
Minnesota budget includes heads to Gov. Bill Lee for his signature. Ten-
small providers to get claims paid timely effect July 1 or it’s for the next round,” she cuts to DMe nessee joins six other states in recognizing
and (address) access issues?” said. hme MINNEApOLIS, Minn. – Minnesota Gov. Tim Walz complex rehab as a separate benefit.
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6 News WWW.hMeNeWS.COM / APRiL 2019 / hMe NeWS
report dAVId cHANdLER
newer businesses is a Medicare Advantage
plan, so I’ve seen where most of the cost
Health share of GDP
c on ti nu ed fr o m pag e 3 comes from and I’ve learned the language
sole-source agreements, trying to be more these payers are speaking—it’s all about
proactive. If that’s ultimately successful, controlling that monthly member cost,”
we need to replicate those efforts across he said. “We need to transform the school
to hit 19.4% by 2027 the country.”
he kNOWS MCOS
“In my role at Liberty, I handle all the
contracting for the business, so I’ve had
of thought to, ‘We’re in the home and we
have the one-on-one interaction with your
members in the home, and we can assist
you.’”
WASHINGTON – national health expenditure 2.5% over 2018-27 compared to 1.1% over direct exposure to MCos,” he said. “Try- he WANTS A SeAT AT The TABLe—AND
growth is expected to average 5.5% annually 2014-17. ing to stay away from Medicare rates is SO ShOuLD yOu
from 2018-2027, reaching nearly $6 trillion Similar to last year’s findings, the report the name of the game lately and, working “If you’re not involved, you don’t have a
by 2027, according to a report published by found that by 2027, federal, state and local with ACMeSA and AAH, a lot of our efforts seat at the table,” he said. “There are a lot
the office of the Actuary at CMS. governments are projected to finance 47% have been around payer relations. We have of challenges in our industry, including
Growth in national health spending is of national health spending, an increase of a great relationship with BCBS of north MCos looking more closely at Medicaid,
projected to be faster than projected growth 2% from 45% in 2017. Carolina; we meet with them quarterly. We and unless you get involved and tell them
in gross domestic product by 0.8% over the As a result of comparatively higher pro- also have a great relationship with Medic- your side of the story, they’re not going to
same period. jected enrollment growth in Medicare, aver- aid in our state.” hear it from anywhere else. AAHomecare
As a result, health share of GDP is pro- age annual spending growth in Medicare he ReALLy kNOWS MCOS won’t be successful without the support
jected to increase from 17.9% in 2017 to (7.4%) is expected to exceed that of Med- “Liberty is a unique business in that it’s part of providers. If you’re not involved, you’re
19.4% by 2027, the report says. icaid (5.5%) and private health insurance of a family of businesses and one of the diminishing the effort globally.” hme
national health spending over the next (4.8%).
decade is expected to be driven by: underlying the strong average annual
4Key economic factors, such as growth
in income and employment;
Medicare spending growth are: projected
sustained strong enrollment growth as the
LOOkup EFFORT ENTERS TESTING
c on ti nu ed fr o m pag e 3
4Demographic factors, such as the baby baby boomers continue to age into the pro- exchange of information between provider the clinical record.
boom generation continuing to age from gram and growth in the use and intensity of and payer. In response to a request from CMS, limited
private insurance into Medicare; and covered services that is consistent with the The DLRS is based on two “use” cases: beneficiary cost information has also been
4Increases in prices for medical goods rates observed during Medicare’s long-term coverage requirements discovery, and doc- included in the DLRS, officials said. That way,
and services, which are projected to grow history, the report says. hme umentation templates and rules. Testing of patients and clinicians can discuss affordabil-
the CRD has begun and testing of the DTR ity and, if necessary, alternative treatments.
begins this month, said officials. CMS has also established two work-
under the multistep process, a physi- groups: A DRLS stakeholder workgroup to
cian ordering home oxygen therapy trig- ensure key challenges and recommenda-
gers a request; the request is generated tions are included; and a DMe e-prescrib-
and returns a template and rules for home ing workgroup to address special challeng-
oxygen therapy; that information is pre- es. for instance, if a physician is checking
populated from the patient’s clinical record the DLRS system to order DMe, what does
in the template; the provider is queried in that look like, what are the challenges and
real-time for any missing information; and what does CMS need to know going for-
finally, the patient information is stored in ward, said officials. hme
ROuNd 2021 BEGINS TO TAkE SHApE
continued from page 1
CMS hasn’t announced yet how long Several groups outside of the HMe
the bid window will be open for Round industry have begun talking about tak-
2021, but Bachenheimer expects it will ing the lead on possible carve-out leg-
be 60 days as in previous rounds. islation to remove vents from bidding,
Also cause for concern: CMS has says AAHomecare’s Tom Ryan.
added non-invasive ventilators to the “from the standpoint that patients
program, despite widespread opposition and physicians believe it’s not a proper
from stakeholders across the healthcare product category, they would be a much
continuum, who submitted between 500 better group to be leading that legisla-
and 600 comments on the proposal in tion,” said Ryan, president and Ceo.
December. “They are already working on strategy
“We’ve already begun talking to the and they have people in mind.”
House and Senate folks,” said Jay Witter, The vent problem aside, stakehold-
senior vice president of government rela- ers were otherwise pleased to see many
tions for AAHomecare. “They are taking of their recommendations incorporat-
this issue very seriously on the Hill and ed in the program, including licensure
folks are asking questions.” and accreditation requirements and bid
bonds, which they say will cut down on
speculative bidding that saw contracts
NEWSpOLL
c on ti nu ed fr o m pag e 3
awarded to companies that were located
hundreds or thousands of miles away.
those exhibitors are also ready to educate In addition to non-invasive vents,
providers. CMS has added off-the-shelf back and
“(We want to) meet customers that will knee braces for a total of 16 discrete
be there and talk to them about possible product categories; and consolidated
new products,” wrote one respondent. the competitive bidding areas included
for some respondents, Medtrade Spring in Round 1 2017 and the Round 2 Rec-
isn’t on the agenda this year, a decision ompete for a total of 130 CBAs.
they’ve made reluctantly. not included in Round 2021: a nation-
“I would love to attend but due to all al mail-order program for diabetes test-
of the cutbacks we just cannot afford it,” ing supplies. The Balanced Budget Act
wrote one respondent. of 2018 mandated several changes to the
This year’s show is slated for April 16-18 program, including strengthening the
at the Mandalay Bay Convention Center in 50% rule and codifying the anti-switch-
Las Vegas. hme ing rule. hme
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8 editorial www.hmenews.com / april 2019 / hme news
Deja vu for a reason
I
T CerTAINLy caught the there? but also the devices themselves!
attention of HMe provid- This is essentially the think- At press time, we were running a poll ask-
publisher
ers when CVS announced ing of provider Andrew Tram- ing providers whether or not the announce-
that CPAP masks would be mell, who spoke with Manag- ment concerned them. The majority said Rick Rector
among the products offered in ing editor Theresa flaherty yes, but the majority also said they think rrector@hmenews.com
three new HealthHub concept for a story on the announce- their customers will keep coming back to
editor
stores in the Houston area. ment (see page 1). them. The biggest reason: their expertise.
In a CNBC story online, “If you have been using the “unless CVS plans to employ knowl- Liz Beaulieu
there was even a picture of same CPAP mask for a long edgeable personnel like an rrT to handle ebeaulieu@hmenews.com
the CPAP masks featured in time, you really don’t need a what is usually the No. 1 complaint of
managing editor
the stores, namely the resMed lIz beaulIeu whole lot of interaction,” he CPAP users (mask issues), I believe they’ll
Airfit series. said. “I think CVS could abso- soon learn DMe companies specialize in Theresa Flaherty
from what I can tell, providers have a lutely be a threat.” this type of service,” wrote in one respon- tflaherty@hmenews.com
steely resolve in the face of the announce- of course, providers always have threats, dent. “However, a move such as this will
contributing editor
ment. Providers are still the ones providing whether it’s CVS or the growing number of temporarily impact the DMe world until
CPAP devices and, therefore, they’re the online providers of not only CPAP supplies patients figure this out.” hme John Andrews
ones with established relationships with editorial director
users. They’re also, largely, the ones mak-
Brook Taliaferro
ing sure that users remain compliant and,
therefore, are the link to being able to con- editorial &
tinue their therapies. advertising office
They’re also feeling like they’ve been
106 Lafayette Street
here before.
And they have. Way back in 2012, Phil- PO Box 998
ips respironics had a pilot project with Yarmouth, ME 04096
Kroger to provide the company’s masks, 207-846-0600
with prescriptions, through some of the (fax) 207-846-0657
grocery store’s pharmacies.
(What came of that pilot project? I’ve advertising
made inquiries to Philips.) account manager
There’s one fear, however, that providers Jo-Ellen Reed
had about Kroger and they still have today jreed@hmenews.com
about CVS. Might users be tempted to just
pay cash for their supplies from a CVS, advertising coordinator
especially if they’re happy with their cur- Cath Daggett
rent mask and if they have a high deduct- cdaggett@hmenews.com
ible insurance plan?
And if CVS is successful with supplies, production director
what makes anyone think they’ll stop Lise Dubois
ldubois@unitedpublications.com
welcome letter from kevin gaffney reprints
For custom reprints or digital reuse,
please contact our reprint partner,
All future, no past at Medtrade Spring The YGS Group, by calling
717-505-9701, ext. 100, or
early on a Vegas morning, but I strongly and even primitive phone calls. unitedpublications@theygsgroup.com
By Kevin Gaffney
encourage you to attend. ultimately, Medtrade Spring is not about
I
art credits
f you’re reading this issue of HMe The update can be a sobering experi- us; it’s about you. It’s our job to make it
Steve Meyers: cartoon
News at Medtrade Spring in Las Vegas, ence, because officials at AAHomecare worth your while, and it’s your obligation
welcome to the show. We recognize must walk that line between to take advantage of what the subscription information
that you’ve spent time, money and effort optimistic and overly optimis- show has to offer. www.hmenews.com/subscribe
to make it to the Nevada desert, and we tic. We walk it, too. The trade If you get on site and want
HME News
believe you made the right choice. show business may indeed be to take advantage of the edu-
once you’re at Medtrade Spring, spend- a business, but much like the cational sessions, you still PO Box 1888
ing time on the show floor, speaking with best of endeavors, our success have time to buy a pass. or if Cedar Rapids, IA 52406-1888
exhibitors and getting new product ideas is directly tied to the industry. you’re still pondering atten- 800-553-8878
are all great ways to spend your time. We resist the urge to fondly dance, go to www.medtrade.
However, if you want structured net- look back at the days before com and see what we have
working events, I encourage you to go to competitive bidding. We can’t to offer. from there, you can
Hall C at the Mandalay Bay Convention afford to do it, and neither can also register for an expo pass
kevIn gaffney Publishers of specialized business
Center and visit the registration area to you. The money is not flowing or a Conference Pass (which
inquire about The Audit “Happy” Hour, like it once was, so we all must also includes an expo pass). newspapers including HME News and
the Power Lunch, AAHomecare’s Stand up find ways to widen the stream or make I hope you get real value from the in- Security Systems News. Producers of
for Homecare fundraiser reception and the river a more efficient ecosystem. Like person experience that is Medtrade Spring. the HME News Business Summit and
the rise & retail Breakfast roundtables. you, Medtrade Spring and Medtrade (oct Cement old relationships, shake hands the Home Health Technology Summit.
While it’s true that the above events 21-23, 2019) must find ways to creatively and create new partnerships and friend-
require advance registration and a fee, remain relevant. Also like you, we are still ships that will sustain you in this tough ceo
AAHomecare’s Washington update on here. business. The people at the show know J.G. Taliaferro, Jr.
Wednesday, April 17, at 8 a.m. in South The so-called digital age did not kill your pain, and your triumphs. Talk to our
president
Pacific f is open to all attendees with no the trade show. Paradoxically, it may have experts. Talk to attendees, and eventually
advance registration and no fee. you do made them more important than ever. In leave the show renewed and refreshed. Rick Rector
not have to be a member of AAHomec- an Internet age, it’s the face-to-face net- That’s the whole idea. hme
are to attend. It will provide fascinating working, education, and outright focus
insight into the challenges, and opportuni- that make an in-person experience so dif- Kevin Gaffney is vice president and group show
ties, that await the industry. It’s a wee bit ferent from e-mail, social media, texting director, Medtrade Spring and Medtrade.
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10 Smart Talk www.hmenews.com / april 2019 / hme news
outSourcing charGe billinG However, not all payer contracts without write-offs. The majority of payer contracts—
Charge billing is full “retail” pricing, are typically loaded, and many are cash the 80/20 rule—need to be loaded
analyze net not including payer contracts and dated and inaccurate, so this can Cash is the actual payment received, and accurate in the provider’s bill-
revenue, actual fee schedules. For most providers, inflate the actual payments. net of any other adjustments. Pro- ing system. Once payments are
this measure inflates expected cash neT revenue viders on cash basis can use this posted, providers should analyze
cash by 100%–200%. Net revenue is allowable billing less measure. net revenue collections and actual
By Joey Graham allowable billinG the additional contractual adjust- so, whaT’s riGhT soluTion? cash to measure revenue cycle per-
Allowable billing is charge bill- ments taken during cash posting, Charge billing is generally seen as formance. hme
Q. What measure should i use to ing less the expected contractual credit adjustments and balance a throwaway measure due to its
track revenues? adjustments based on fee schedules transfers. It is calculated after a extreme inaccuracy. Instead, pro- Joey Graham is the executive vice presi-
a. HME providers are split on how and contracts with payers. This is payment has been made and indi- viders turn to allowable billing as dent and general manager at Prochant,
best to measure and recognize rev- typically a provider’s “best guess” cates exactly what a provider should their revenue measure prior to get- Inc. Reach him at joeyg@prochant.com
enue in their businesses. upfront of what they will get paid. expect to see in payments in a world ting paid and posting payments. and (980) 201-3082.
SucceSSion planning
Start planning
well in
advance
By miriam LieBer
Q. When and how should i start
thinking about a succession plan?
a. Begin planning well before a
successor will be needed. Start
with skill building for the identi-
fied core group of staff. Teach and
train leadership techniques to the
most skilled and talented group of
employees at your company. Invest
in coaches and mentors to help
them strengthen their leadership
skills. Sometimes, the CEO is the
best mentor; other times, outside
mentors are needed to develop a
leader. Make sure you have more
than one person in the pipeline as
We’re looking for the depth is needed to develop a core
team of employees who will take
you to the next stage.
Goals
Provider of the Year! To create a real bench, you will
need goals and metrics to know
how well staff and leaders per-
form. Goals can be as simple as
how much outstanding A/R over
Accepting applications for the HME Excellence Awards 120 days you carry to net reve-
nue by product and payer that is
paid within 45-60 days. With the
We’re looking for providers who excel in customer service, value their employees, right leaders, you will know if
your staff measures up to expec-
generate solid financials and give back to their communities. If that’s you, apply for tations. Make sure they under-
stand what those expectations
the Provider of the Year Award! It’s quick and easy to apply online. are (many are part of the goal
setting practice so they should
be keenly aware).
You could win an HME Databank subscription ($995 value). All applicants will be The leader in this case has been
successful in training the team how
entered into a drawing for a free one-year subscription to the HME Databank. to improve productivity through
objective measure and metric.
TraiTs
A list of the CEO’s required per-
sonality traits and leadership
skills should be documented.
Bonus: The winner gets two FREE Learn the candidate’s strengths
and weaknesses that are both
objectively and subjectively
registrations to the 2019 HME News measured. Some are quantifiable
and other traits are simply suc-
Business Summit, September 22-24 cess oriented skills and motiva-
tional drivers. Additionally, test
in Cleveland! Business Summit the potential leader by having the
person act as leader on a project
as a case study to determine if
they are suitable for the chief
executive position. hme
Application deadline: June 6
Miriam Lieber is president of Lieber
www.hmeexcellenceawards.com medtrade booth 815
Consulting LLC. Reach her at Miriam@
lieberconsulting.com.hme news / april 2019 / www.hmenews.com Smart Talk 11
Marketing in the HME space are not making willing, a simple point-and-shoot a real user interacting with your As Tony Robbins would say, “If you
videos and, therefore, you would camera makes a world of difference. specific product. (Ask them to use stay in your head, you’re dead.” I’m
likely be a pioneer in your field. In Software like Movie Maker (PC), landscape orientation, or, even bet- not saying disregard quality, set a
2018, Forbes reported that 90% of Final Cut Pro (Mac), or Animoto ter, they have someone else holding standard and stick to it. However,
Set standard, online shoppers find videos impor- (Cloud-based) offer intuitive inter- the camera). do not stop your growth because
stick to it tant in steering purchasing deci- faces that produce great content. sTock where necessary your videos don’t look like compa-
sions. creaTe massive value There are numerous sites like Getty ny X or you don’t have the budget
By Scott Stone
iT sTarTs in your pockeT Consider value from all angles. You and Shutterstock that offer stock of company Y. Comparison is the
Q. How can i make videos—it You do not need to invest in thou- can make marketing videos that videography for your content gaps. killer of progress. hme
seems out of reach for a company sands of dollars of video gear or showcase the lifestyle achieved As often as possible, only use con-
of my size? software to make valuable content. with your products or even simple tent that has real users and/or real Scott Stone is president of Community
a. Video marketing is within reach Most Android and iPhones shoot testimonials that you elicit from equipment. Conscious Consulting. Reach him at
for any company. Most companies in HD, new ones in 4K. If you’re your customer base to showcase check The eGo scott.marshall.stone@gmail.com.
accreditation
go beyond
documentation
By KeLLy WoLfe
Q. How can i keep up with
documentation?
a. One of the accreditation
requirements is to have and
maintain a performance manage-
Your business will
ment plan. Although providers
provide this documentation at
the initial accreditation survey,
many fail to implement it after
bloom with our data!
the survey. This is an important
factor and requirement to main-
tain your accreditation. This is
also a valuable tool to help your
company correct issues and make
you shine above the competition.
Frequency oF billinG and
Subscribe to the HME Databank and gain access to the
codinG errors
Make sure you review the num-
most comprehensive database of Medicare data for HME.
ber of claims denied, as well as
billing and coding errors. Make
sure you have your staff main-
• Determine your market share Downloadable in
tain your billing error log. Not two formats:
only will this allow you to find • Track competitors
areas of weakness, but it will also
PDF Excel
help improve your cash flow and
accuracy.
• Strategize for growth
paTienT, reFerral source,
and employee evaluaTions
and surveys
All feedback is helpful in deter-
mining how you are doing as an
organization. This will allow you
Data
to find any deficiencies within the
structure of your organization.
Samples
Make sure your staff is record-
ing complaints in the complaint
Online!
log. Medicare requires that this
log contain the HIC number and
DATA
proof that you are responding
to the patient with the results
of your investigation within 14
days.
adverse eFFecTs For
malFuncTioninG equipmenT
Make sure you record any inci-
dents or injuries that occur as
a result of your services. Hope-
fully you are not in that boat but
if you find yourself in that situa-
tion maintain detailed documen-
tation. This could include manu-
facturer, attorney and insurance
paperwork. Keep in mind that
you have a limited timeframe to
research and report. hme
www.hmedatabank.com
Kelly Wolfe is president of Regency
Billing and Consulting. Reach her at
kellyw@regency4dme.com.
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medtrade booth 527■ For a certain type of Impact of gap period differs by area . . . . . . . . . . . . . . . . . 13
customer, CVS’s HealthHUBs Q&A: Daina Juhansoo offers hospital perspective. . . . . . 13
Providers
could create some
competition, says Andrew
Providers cultivate customer reviews . . . . . . . . . . . . . . . . 13
Trammell. See story page 1. Reporter’s notebook: Mike Kuller on CVS . . . . . . . . . . . . 14
www.hMENEws.COM / aPrIl 2019 / hME NEws 13
Briefs competitive bidding
Contracts
PE firm invests in
Montgomery DME
LOS ANGELES – Monument MicroCap Part-
Impact of gap period? open up,
ners has recapitalized Montgomery DME
(MDME), a provider of DME to hospices
in Los Angeles and surrounding coun-
ties, according to PEHub.com. Monument
A bit too early to tell but little
and MDME also closed the acquisition of
Abundant Home Care to create a regional
provider of DME to hospices throughout
By Theresa FlaherTy, Managing editor
YARMOUTH, Maine – What has been the
or seven months, that’s when the rubber
meets the road.”
Ackerman said he’s pulled back his
changes
southern California. “We are excited to By Tracy Orzel, contributing Writer
impact of a two-year gap between com- perimeter for delivering small-dollar items
partner with Monument and AHC on the petitive bidding contracts? It all depends like walkers, although he’s EAST SANDWICH, Mass. –
Since CMS let com-
next chapter of our growth strategy,” said who you ask. giving more leeway to reg- petitive bidding contracts expire on Dec.
Pablo Miguel, vice president of MDME. The primary concern going into the ular referral sources. 31, 2018, Daina Juhansoo was hopeful
“Monument will provide us with strategic gap period: Whether Medicare beneficia- In other areas, already that providers, previously locked out of
support and capital as we continue with ries will lose access to HME if providers, underserved during the the program, would want Medicare busi-
our steadfast commitment to providing the no longer bound by contracts, shrink contract period, the situa- ness again. HME News recently spoke with
highest quality of compassionate service service areas, refuse to accept assign- tion has become dire. Juhansoo, director of inpatient rehabilita-
to our clients and their patients.” Monu- ment, or otherwise limit how much “ H o s p i t a l s a re n o t tion at Spaulding Rehabilitation Hospital
ment MicroCap is an Indianapolis-based Medicare business they want to accept. able to get people beds Cape Cod, about how the competitive
private equity firm. In the short term, at least, an any will- S. Ackerman and wheelchairs because bidding program has impacted access and
ing provider provision may be softening they are not being taken whether it has improved in the new year.
Protech reports
the blow in some areas. assigned—the reimbursement rates are HME NEws: What issues were you facing
4Q financials “There were a number of people (in so low,” said George Kucka, president before the contracts expired?
WILDER, Ky. – Protech Home Medical re- our area) that came back into it, which of fairmeadows Home Health Center in Daina Juhansoo: Being on Cape Cod we
ported $20.3 million in revenues for the we are thinking may have artificial- Schererville, Ind. “It’s the same with liq- have a good number of patients whose
fourth quarter of 2018, ended Sept. 30, ly filled what have been an automatic uid oxygen, and I think it’s going to get Medicare home zip code is 60 miles away
2018. Net income for the quarter was access problem right out of the gate,” worse.” or more from our facility. We had to go
nearly $1.4 million; and adjusted EBITDA said Steve Ackerman, CEo of Spectrum for some, business is better than through the process of identifying the
for the quarter was $5.2 million or 26%, Medical in Silver Springs, Md. “But in six GAp per i o d s e e pag e 1 4 jU H A N S O O s e e pag e 1 4
a company record, according to a press
release. The company reduced bad debt to
Providers court
$5.2 million, compared to $15.9 million the
previous year. Cash on hand was $4.3 mil-
lion, an increase of 27% compared to the
previous year. Protech in January acquired
Riverside Medical and Central Oxygen for
about $871,000.
New CEO to take reins
online reviews
at Integra Partners
70% of consumers reviews.
trust online reviews as “If somebody is talking
NEW YORK – Integra Partners has named about something they got or
Dominic Paniccia as its new CEO, effec- much as they trust a how much they love what
tive March 31. Paniccia succeeds Andrew family member you did for them, you’ve got
Saltoun, who will serve as a senior adviser to say, ‘We’d love a facebook
to the organization, according to a press By Theresa FlaherTy, Managing editor
or Google review,’” said Kevin
release. Paniccia joined Integra as CFO in o S T H M E p ro v i d - Brown, co-owner of Hermitage,
2016 and was named president in 2018.
Under his leadership, the company has
created a new customer-centric model that
M ers have some sort of
online presence, but
it’s important to manage that
Tenn.-based All Star Medical. “It
increases visibility.”
Even if providers aren’t active-
THis GooGlE lisTiNG hasn’t been claimed.
Own your online rep
has improved operations and increased presence, particularly reviews ly seeking out online reviews,
revenues. Previously, Paniccia has held of their businesses, experts say. it’s a good idea for them to and you see “Do you own this
leadership positions at American Express, By Theresa FlaherTy, Managing editor
Google, yelp and facebook monitor what others are saying business?” “claim” it, says
AIG and CB Insights. “I’m honored to be are among the most widely about them, Throndson says. f you’RE still in the dark Throndson.
appointed to this position,” said Paniccia.
“Integra is growing, and we’re focused on
doing what we can to achieve our mission
used tools for reviewing prod-
ucts and businesses, and a lot’s
at stake. VGM forbin’s Chris-
Provider Johnny Miller learned
that the hard way.
“We realized we had some
I when it comes to what’s
being said about your busi-
ness online, it’s time to shine
“This allows you to have
your hours on there, park-
ing information and reviews,”
of reducing the friction in health care— tina Throndson says 70% of not-so-kind reviews out there a light on it, says Christina she said. “It
making things easier for our clients, which consumers trust online reviews on Google and that wasn’t the Throndson, vice president at also pairs up
includes health plans and providers—as as much as they trust a family whole story of who we are, what VGM forbin. up with your
we manage these benefits.” member’s opinion. we do and how we do it,” said “Whether it’s good, bad or Google map
“Reviews have an incredible Miller, owner of Akron, ohio- indifferent, make sure you (to show your
Name change impact on your end users and based Miller’s. “We thought, own your presence and it’s up location).”
AUBURN, N.Y. – Homecare Medical Sup- making sure they can trust you,” ‘Let’s be proactive and not let the to date,” she said. “That’s low- The listing
ply has changed its name to Respiratory said Throndson, vice president naysayers write the narrative.’” hanging fruit.” can be set up
Services of Auburn, according to a local at VGM forbin. “It helps your Miller’s now routinely asks Throndson spoke with HME with a Google
news report. The company has five oth- C. Throndson
online presence, so it’s impor- customers for Google reviews. It News recently to offer a few account so
er branches in the region. The company, tant to get these reviews.” has also implemented a rewards basic pointers for managing you can receive notifications
which was founded in 1983, was acquired That often means provid- system for employees who your online presence. and leave responses when a
in July by Respiratory Services of Western ers can’t be shy about asking receive five-star reviews online. review is left.
GOOGlE It
New York. customers upfront for online ON LI N E r ev ie ws se e pa g e 14 If you Google your business R Ep U TAT I O N s e e pag e 1 414 Providers www.hMENEws.COM / aPrIl 2019 / hME NEws
notebook HEALTHHUBS
c on ti nu ed fr o m pag e 1
CVS may not like DME “As a pharmacist, I understand a lot
a way they say the CVSs and the Amazons
of the world can’t.
“Whether someplace like CVS or Wal-
greens that sells products in boxes is
By Theresa FlaherTy, Managing editor
about the underlying conditions custom- going to take the time to help the person
PHARMACIST By training and an ers have and I’ve been doing DME for 20 remains to be seen,” said Kuller. “And
A HME provider by trade, Mike
Kuller offers a unique perspec-
tive on CVS’s plans to roll out expanded
years,” he said. “So, I understand how
the equipment’s being used. People tell
me we’re great—they don’t want to talk
they have nowhere to get parts or nobody
to fix it. That’s not going to change with
CVS.”
health services, education and DME offer- to that young kid that for HME providers, the relationship
ings through its HealthHuBs. doesn’t know what he’s with customers extends beyond selling
In some ways it makes a lot of sense for doing.” products, especially when it comes to
CVS, which already offers walk-in health Kuller also questions managing chronic conditions like sleep
services like screenings and vaccinations whether CVS will want apnea. Helping the patient maintain
through its MinuteClinics, to try and cap- the hassle of insurance compliance takes time and effort, say
ture a larger share of the healthcare mar- billing for DME, which providers.
ket, says Kuller, owner of Allstar Medical is different than billing “They might succeed at quick grab,
Supply in Walnut Creek, Calif. Mike Kuller
for prescription drugs; cash-and-carry items, but for long-term
“It’s probably a good idea where they and whether it will find customer retention?” says Woody o’Neal,
are headed,” he said. “My daughter had it cost-effective in the long run. vice president of Pelham, Ala.-based o2 A CVs HEAlTHHUB prototype features
pink eye and, at 6:30 at night, it was con- “They are going to have to figure Neal Medical. “Not sure the CVS model consulting areas.
venient and the only option.” out whther they want to sell retail, and lends itself to customer intimacy the way mask for a long time you really don’t need
However, while targeting chronic how to cover the cost of teaching these a successful DME operates.” a whole lot of interaction (when buying a
health conditions like diabetes and sleep health classes and engaging with people However, other providers say experi- new one),” said Andrew Trammell, presi-
apnea makes sense, how that will trans- at kiosks,” he said. “When I go in just to enced patients might well choose to pop dent of Charlotte, N.C.-based Carolina’s
late to also offering medical supplies like pick up a prescription, there’s already five into CVS for a quick replacement mask HME. “(If the business model is) set up
CPAP is another story, he says. people waiting in line.” HME or supplies. properly, I think CVS could absolutely
“If you have been using the same CPAP be a threat.” HME
jUHANSOO
c on ti nu ed fr o m pag e 1 3
REpUTATION
c on t in ue d f ro m pa g e 1 3
vendors that we were allowed to use at “We often just think, ‘oh, I have positive
time of discharge. understandably, they reviews, I don’t need to reply to those,’ but
often did not want to drive 60 miles to you absolutely do,” she said. “If I come to
deliver a cane or a walker and so we your business and thank you in person or
wound up in a jam—often. on the phone, are you going to walk away
HME: Now that the lockout has ended, has or hang up? No. It’s the same thing online.
it gotten better or worse? That’s a huge missed opportunity to con-
Juhansoo: It’s the same. We were fool- nect with your customers.”
ishly excited that we would now be lIkE It
able to use our local vendors to get all facebook is another platform where it’s
of the needed DME. Knowing that the simple to manage business reviews, and if
contracts expired, we called our clos- you aren’t, you should make sure no one
est vendors and were told they weren’t else is, either, says Throndson.
able to supply the requested equipment “If you have never created a face-
because of the competitive bidding pro- book page but have customers that have
gram. When we reminded them that it’s ‘checked in,’ that gives users the ability to
no longer in effect, they responded that create one,” she said. “That can be a prob-
they have not changed their practice. I lem if you can’t control them.”
Community Pharmacy Accreditation: understand that they’re in a terrible situ-
ation and they’re just trying to survive an
once again, claim the business. you will
be asked to verify your phone number—
The path to value-based care. untenable position.
HME: CMS says it plans to overhaul the
program over the next two years. Are you
there’s usually an option to receive a mailed
postcard with a verification code sent to
your physical address.
S
ervice specific and scalable, The Compliance Team’s Exemplary hopeful? “That proves that it’s legit and you, as
Provider® accreditation for Community Pharmacy gives Juhansoo: I suppose I should reserve the business owner, can have access to
independents as well as chains a cost-effective means to validate judgment until they roll out their next the reviews that come in and the calls that
quality claims across the full spectrum of your business operations and attempt, but I can’t imagine how they come in via that number,” she said. “It’s
patient care practices. would have thought that this first pro- incredibly helpful and it’s free.” HME
gram would have been successful. HME
In addition to being Medicare approved for Part B—DMEPOS, our
proprietary operations-based accreditation process can easily expand to
cover compounding, infusion, specialty drug, travel/retail clinic, GAp pERIOD ONLINE REvIEWS
c on t in ue d f ro m pa g e 1 3
long-term care, and telepharmacy services; topped off by Patient- c on ti nu ed fr o m pag e 1 3 “It incentivizes the employees to let the
Centered Pharmacy Home™, our program for advanced Rx practices. Mesa, Ariz.-based Valley Healthcare, end user know if they mention staff by
which previously held several contracts name online they earn a reward,” Miller
For more details, call us at 215 654 9110 or visit our web site: for respiratory, is adding business through said.
TheComplianceTeam.org. Portland, ore.-based Northwest Medical, If, in checking their online presence, pro-
which it acquired in September and which viders find bad reviews, they need to react
did not have contracts. constructively.
Visit us at “for us, it’s all new business coming “We’re not perfect, but when a review
Medtrade in and we are seeing a healthy increase of is posted there are many cases where you
YEARS
1994-2019
Spring doctors who are happy to have another are able to respond to it and have that bad
*The Compliance Team, Inc. is approved by the Centers for Medicare and Las Vegas provider for Medicare,” said Ron Evans review removed or the rating increased,”
Medicaid Services to accredit Part A-Rural Health Clinic, Patient-Centered
Medical Home, and Part B-DMEPOS providers.
Booth #831 founder and CEo. “We added two dedi- Miller said. “We respond to every review.
cated marketing professionals that are get- We want folks to know we are paying atten-
ting the word out.” HME tion and we are responsive.” HME
MEdTrAdE BooTH 831You can also read
