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Courtesy of Managed Healthcare Executive – June 19, 2020 – Deborah Abrams Kaplan

Jen Singer became sick with an unidentified respiratory illness while visiting Seattle in February, before many knew enough to be worried about COVID-19. The fever and coughing delayed the 53-year-old’s trip back home to New Jersey.

During an April telehealth visit, Singer didn’t have traditional COVID-19 symptoms. She felt abdominal fullness and had difficulty breathing when climbing stairs. Suspecting a gallbladder issue, the doctor sent her to the emergency department (ED), where her heart rate hovered near 40 beats per minute. A normal resting rate is 60 to 100. Singer’s diagnosis? Fluid buildup in her liver from a third-degree heart block – and she tested positive for COVID-19. She was treated with a pacemaker.

“For the entire month of March, I was taking my temperature (at home), when I should have been measuring my heart rate. If I’d had a pulse oximeter, I would have known that my heart rate had dropped to 42, and I would have rushed to the hospital sooner,” Singer says.

At-home pulse oximeter purchases have spiked more than 500% since the first COVID-19 case was identified in the U.S. The device can easily be purchased at drugstores and online retailers for as little as $40. But not all doctors agree that they’re helpful or that people need to self-monitor for potential COVID-19 exposure. False positives can cause unnecessary anxiety and lead people to seek unnecessary medical care. Many physicians, however, see pulse oximeters as an important way for people to identify declining lung function early and address the cause, including COVID-19, when it’s easier to treat.

Adjunct to Telehealth

Pulse oximeters are noninvasive clips typically used on the finger or the earlobe that measure light wavelengths to determine blood oxygen level. More precisely, the light is a measurement of  the proportion of hemoglobin in the blood that is “saturated” with oxygen. A normal saturation level is 94% to 100%. Pulse oximeters also take a pulse, thus the “pulse” in pulse oximeter, and are commonly used in hospitals to monitor patients.

At-home pulse oximeters were in use before the COVID-19 outbreak, especially by people with chronic heart or lung problems. People getting supplemental oxygen use them to adjust the flow as needed, explains Albert Rizzo, M.D., FACP, chief medical officer of the American Lung Association. Some athletes use them for fitness monitoring.

In late April, the American Lung Association put out a statement that quoted Rizzo as saying that “unless you have a chronic lung or heart condition that affects your oxygen saturation level on a regular basis, most individuals do not need to have a pulse oximeter in their home.” The same statement said the lung association advised against buying pulse oximeters unnecessarily.

The role of pulse oximeters for people with chronic health problems that affect their lungs ad breathing is well established. Just as patients with chronic conditions use devices like blood pressure cuffs and glucose monitors, “home monitoring of oxygen is a way for patients to become familiar with their baseline saturation and to monitor themselves for decompensation,” says Lisa Moreno-Walton, M.D., FAAEM, a professor of emergency medicine at the LSU Health New Orleans School of Medicine and president-elect of the American Academy of Emergency Medicine. The patient and treating physician should determine a target number for when to seek medical help. Pulse oximetry can be a great adjunct to telemedicine, she says, providing useful information to inform further medical care. Ideally, patients should first use the device with guidance from a physician to be certain they’re using it correctly and that the readings are consistent with the pulse oximeters at the medical practice or hospital.

Some physicians believe that pulse oximeters can save lives amid the COVID-19 outbreak by prompting people to get medical help sooner.  COVID-19 patients (how many is unclear) have shown up at the ED with “silent hypoxia,” abnormally low oxygen saturation levels without breathing difficulty. Silent hypoxia is not specific to COVID-19, but it may be more common than with other lung infections.

Over-reliance on a pulse oximeter and a good saturation rate can give a false sense of security, warns Rizzo, because oxygen saturation and heart rate are only two factors for  determining a person’s condition. For COVID-19, Rizzo says that a doctor would also consider shortness of breath, fever, cough, gastrointestinal symptoms and headache.

Pulse oximeters are available for as little as $25. It’s simple technology, says Rizzo. “You get what you pay for, but spending a couple hundred dollars isn’t necessary,” he explains, adding that if a cheaper one gives consistently accurate levels, it’s probably fine.

Patients should know that a pulse oximeter may be less accurate if they’re wearing dark or gel nail polish, says Rizzo. Cold fingers or poor circulation may also affect pulse oximeters. People should not rely on a single reading and should take measurements multiple times throughout the day to evaluate trends.

Now home from the hospital, Singer uses her $50 Ankovo pulse oximeter regularly. She also sent one to her college-age son as part of a care package – along with heart-healthy oatmeal.

If interested in a pulse oximeter, please click here:

White Paper Demonstrates Value of Incontinence Providers

Wednesday, July 1, 2020 @ 07:07 AM  posted by jbuytaert

courtesy of HME Business – by David Kopf, June 25, 2020

The document aims to educate regulators and payers on the importance of high-quality incontinence solutions supplied by knowledgeable providers in ensuring optimal care and cost management.

HME providers supplying incontinence products and services are critical in ensuring optimal incontinence patient care and cost management, according to a new white paper.

Moreover, the white paper, “Keeping Patients at Home with Improved Outcomes Through the Use of Quality Incontinence Products and HME Providers,” says that recent Medicaid and MCO funding trends are hampering those providers’ ability to help those patients.

“Matching the end-user with a product that meets or exceeds the National Association for Continence premium standards is essential—but selecting the right product or products and ensuring that the size and fit are appropriate for the end-users while providing ongoing supportive services are also key elements,” the white paper states.

The document was produced by a subgroup of the American Association for Homecare’s Medical Supplies Council, the Wound Ostomy and Continence Nurses Society (WOCN), the Society of Urologic Nurses and Associates (SUNA), and National Association for Continence (NAFC). Their goal is to educate payers and regulators on the importance of using high-quality incontinence products provided by knowledgeable HME providers that can manage end-users’ needs and prevent costly complications.

“The factors involved with managing the incontinent patient are complex, and if poorly managed, can lead to increased costs to the payer to treat the resulting complications,” said Gayle Devin of ActivStyle, who chairs AAHomecare’s Medical Supplies Council and the subgroup who developed the paper.

The white paper can be downloaded as a PDF.

Decline in HME providers strains those that are left

Monday, June 29, 2020 @ 12:06 PM  posted by jbuytaert

Courtesy of HME News, by: Theresa Flaherty – Friday, June 26, 2020

Medicare’s competitive bidding program has decimated their ranks over the past 10 years and now those HME providers that are left are in the middle of a pandemic and facing Round 2021.

The industry has seen a significant decline in providers nationwide since the bid program debuted in 2011, ranging from 48% in Illinois and Arizona to 13% in Maine and Alaska, according to the VGM Group.

“Reimbursement cuts from bidding have made it almost impossible for providers to provide products at any kind of profitable margin,” said Ron Evans, co-founder and CEO of Mesa, Ariz.-based Valley Healthcare. “There were a lot of very good companies just in Phoenix, companies that provided good quality care, that either aren’t able to survive or are struggling to.”

Particularly in rural states, those providers that are left are being asked to pick up patients who no longer have providers. Evans has received calls asking if the company has considered expanding into certain underserved areas.

“We’ve had opportunities to pick up new patients,” he said. “By the same token, it’s not the way you would want to grow.”

It’s the same story in Texas, which has seen a 44% decline in providers. Kevin Hill has had to streamline operations at his 40-year-old company, even as he picks up patients from former competitors. Read more

Courtesy of AA Homecare


Incontinence, also known as the loss of bladder or bowel control, is a common problem among older adults as well as people with disabilities. Urinary incontinence can lead to unwarranted physical, psychosocial, and economic burdens on both the patient and their caregivers. This is the first of a two‐part white paper series to address the types of products and services needed to successfully manage an individual’s incontinence needs; the next paper will address the use of ostomy and urology products.

Annual costs of managing and treating incontinence in the United States is estimated to cost $65.9 billion, with $51.4 billion directly related to medical care, such as medical treatments/procedures, supplies, medication, hospitalization, long‐term care stays, physician visits, and laboratory tests (Coyne KS, 2014). Failure to properly manage incontinence results in medical complications including incontinence‐associated dermatitis (a known precursor to ulcers and pressure injuries), urinary tract infections, falls, and psycho‐social issues.

Home Medical Equipment (HME) providers who provide incontinence products and services are critical to patient (end user) care and cost management. They work with the prescribing health care provider and end user to properly manage the individual’s incontinence needs by matching the person with the appropriate product(s) to ensure proper fit and size and providing essential services and ongoing monthly support in a costeffective homecare setting. To optimize end user experience and outcomes while decreasing utilization and the overall cost of care, HME providers use high quality products that meet or exceed the National Association for Continence (NAFC) premium standards.

However, recent payer trends in the Medicaid and MCO market have challenged the HME provider community. Unsustainable rate reductions prevent HME providers from being able to provide premium products, as well as products that meet the patient need and optimize self care, and provide services such as monthly consultations with the end user/caregiver to manage incontinence. Without these premium products and services, the total cost of care increases significantly while patient outcomes and satisfaction deteriorates.

By ensuring adequate reimbursement for quality products by reputable HME providers, payers can achieve the triple aim of improving the end user’s experience and quality of life, creating better health outcomes, and reducing the overall cost of care.


People with Incontinence

51% of females and 21% of males deal with incontinence at some point after 65 years of age. Females are 1.7 times more likely than males to become incontinent during their life span (Gorina, 2014).

Studies estimate that bladder incontinence alone costs $20 billion dollars annually (American College of Chest Physicians, 2014). In addition to the cost associated with products and services needed to manage an incontinent condition, many complications and added costs can be attributed to daily management. Adults who suffer from incontinence also have a high risk of falls, UTIs, and complications with skin breakdown due to being in contact with the high acidity of urine and or stool (Health Economics Resource Center, Department of Veterans Affairs, Sanford University School of Medicine, 2002). Incontinence also affects sleep quality, which can lead to increased daytime sleepiness, increased fall risk, and cognitive impairment among other problems (DeMarinis M, 2017). Incontinence can contribute to social isolation which can lead to depression; according to the Boston Area Community Health Survey as published by the National Institutes of Health, symptoms are also linked to “anxiety… fear of incontinence, and hopelessness” (Kupelian V, 2009) (Elstad E, 2010) (Tang D, 2014). Read more

CMS opens up telehealth to therapists

Monday, May 4, 2020 @ 07:05 AM  posted by jbuytaert

Courtesy of the HME News
by: Liz Beaulieu – Friday, May 1, 2020

WASHINGTON – CMS announced last week that it will allow occupational therapists and physical therapists to provide telehealth services during the coronavirus pandemic, a big win for complex rehab stakeholders.

The agency has waived the limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Previously, only doctors, nurse practitioners, physician assistants and certain others could provide these services.

“This has been a major request from us, along with others,” said Don Clayback, executive director of NCART, during a webcast last week. “This opens up significant opportunities for OTs and PTs, not only for complex rehab but also other areas.”

What’s more, CMS announced that it added CPT 97542—a code used by OTs and PTs for “wheelchair management”—to the list of approved codes for telehealth services.

The agency paved the way for this to happen by changing its process of adding new telehealth services to a sub-regulatory process, instead of a rulemaking process, allowing it to consider requests by practitioners.

“It’s a positive that they’re opening up a new system…that will enable them to be more responsive to practitioners actually using those codes,” Clayback said.

NCART will take these latest changes from CMS and share them with state Medicaid programs that have not already allowed OTs and PTs to provide telehealth services.

“The fact that Medicare is opening that up officially should make those states more comfortable,” Clayback said.