Industry Insider News

OIG Releases HBOT Compliance Report   

Following a review by a contractor with the Centers for Medicare & Medicaid Services (CMS) that found claims for hyperbaric oxygen therapy (HBOT) services were denied because of a lack of medical documentation, the Office of Inspector General (OIG) has reviewed and identified issues with Medicare payments for HBOT. The recent review focused on one Medicare Administrative Contractor (Wisconsin Physicians Service [WPS^®]) due to the high volume of paid outpatient claims that contained HBOT services. The objective was to determine whether WPS paid providers in 2013 and 2014 for HBOT services that complied with Medicare requirements, according to OIG officials.

The review covered 44,940 outpatient claims totaling $59.5 million for Jurisdiction 5 that contained HBOT services provided to Medicare beneficiaries during calendar years 2013-14. A stratified, random sample of 120 outpatient claims was selected and an OIG medical review contractor subsequently reviewed the medical records for compliance with Medicare requirements.

The review found that WPS paid 73 providers for HBOT services that did not comply with Medicare requirements. Of the 120 sampled outpatient claims totaling $438,210, WPS made payments for HBOT in accordance with Medicare requirements for 18 claims. However, WPS made payments for HBOT that did not comply with Medicare requirements for 102 claims, resulting in overpayments totaling $300,789. WPS made payments for HBOT that did not always comply with Medicare requirements because it had limited policies and procedures in place to ensure that it made correct payments, according to the OIG report. Based on OIG results, it is estimated that WPS overpaid providers in Jurisdiction 5 $42.6 million during the audit period for HBOT that did not comply with Medicare requirements.

Since the release of the report, the OIG has made several recommendations to WPS, including that it recover the appropriate portion of the $300,789 in identified Medicare overpayments; notify the providers responsible for the 44,820 non-sampled claims (potential overpayments estimated at $42.3 million), so that they can investigate and return any identified overpayments; identify and recover any improper payments for HBOT made after the audit period; and strengthen its policies and procedures for making payments for HBOT, which the OIG claims would result in millions in future cost savings. According to OIG officials, WPS has “generally agreed with our recommendations … and has taken corrective actions to address issues with the overuse of HBOT … and has conducted further data analysis to identify providers and diagnosis codes at risk for overutilization and offered education to providers about the proper use of HBOT.” In 2015, WPS initiated CMS’ Non-Emergent HBOT Prior Authorization demonstration program in Michigan. Copies of the report can be obtained by contacting officials at public.affairs@oig.hhs.gov. 

Minority Physicians To Form Alliance

In an attempt to make their voices more clearly heard in Washington, DC, and other regions, several minority physician groups are planning to form an alliance, according to a report by MedPage Today.

The National Hispanic Medical Association, National Medical Association, Association of Black Cardiologists,
National Council of Asian Pacific Islander Physicians, and Association of American Indian Physicians are expected to formally announce their alliance sometime in March, according to the report. n

SANUWAVE Nets $1 Million Equipment Financing Line 

SANUWAVE Health Inc., Suwanee, GA, has signed a $1 million equipment financing lease agreement with NFS Leasing Inc., Beverly, MA. According to SANUWAVE officials, the agreement will enable the company to begin placing its dermaPACE^® System in the hands of clinicians and wound care centers in the United States to utilize in the treatment of diabetic foot ulcers (DFUs). The line will reportedly allow the company to distribute dermaPACE domestically without dilution to current shareholders. 

“The agreement with NFS is a crucial announcement for the company as we execute our plan for a successful rollout in the massive U.S. DFU market,” said Kevin A. Richardson II, chief executive officer of
SANUWAVE. “This allows us to access capital to place devices, which in turn will drive procedures and ultimately revenue. We have a well-developed plan in place to roll out dermaPACE methodically throughout 2018. We are very excited to have this line in place, which allows us to launch our rapid revenue growth.” 

Smith & Nephew Announces European Launch of PICO 

Officials at Smith & Nephew, a global medical technology business, have announced the European launch of the new PICO 7 Single Use Negative Pressure Wound Therapy System (sNPWT).

PICO 7 delivers a number of enhancements that benefit both the clinical effectiveness and patient experience, according to company officials. Clinically, PICO 7 delivers a more efficient vacuum and superior leak management, and is designed to support improved application on anatomically challenging areas where it is traditionally more difficult to achieve and maintain a seal. It also includes an industry-first dressing-full indicator for sNPWT devices, which is intended to reduce unnecessary dressing changes and wastage, officials said. For the patient, PICO 7 is more than 25% quieter than the previous version, making it less intrusive and of particular value when the patient is outside the home or is sleeping. There is also a new user interface to simplify patient operation and a belt clip to improve portability.

“Having tried PICO 7, I can confirm that it has real clinical, economic and patient benefits,” said Theresa Hurd, RN, MScN, PhD, in a prepared press release. “With the new PICO 7 system I can be confident that we will experience fewer leaks and can hence reduce the number of nurse interventions, reducing costs, and improving care.”

PICO 7 is designed for patients at risk of poor healing and has been shown to help minimize the failures of healing that may lead to infection and/or dehiscence, officials said. It is suitable for use in both a hospital and community setting, and is approved for a number of indications, including surgically closed incision sites. A recently published meta-analysis demonstrated the efficacy of PICO used prophylactically for surgical site infection reduction in closed surgical incisions compared with standard care.

“With PICO, we revolutionized the use of [NPWT], making a treatment previously only available in a hospital inpatient setting available to outpatients in a clinical and cost-effective portable solution,” said Paolo Di Vincenzo, Smith & Nephew’s senior vice president of advanced wound management. 

ACell Inc. Announces New Distribution Agreement

Officials at ACell^® Inc., Lafayette, IN, have announced a new distribution agreement with Applied Tissue
Technologies (ATT), Hingham, MA, that results in ACell being the exclusive distributor of ATT’s Xpansion^® micro-autografting kit, according to company officials. Xpansion offers a novel approach to split-thickness skin grafting procedures used to manage complex wounds, officials said. Autologous split-thickness skin grafts are the standard of care for achieving wound closure in many clinical settings. However, the procedure still has challenges, including poor skin quality, infections, scarring, and poor cosmetic outcomes. In addition, the need to harvest skin from the patient can lead to additional donor-site complications. The micro-autografting kit facilitates durable closure of complex wounds while maximizing the ratio of donor skin to wound bed area – minimizing the size of painful donor sites, officials said. In addition, the kit can be used with only local anesthetic, providing physicians with the option to perform procedures outside of the operating room.

“The Xpansion micro-autografting kit is a strong complement to ACell’s core MatriStem UBM^™ devices,” said David W. Elliot, ACell’s vice president of marketing. “UBM devices like Cytal^® or MicroMatrix^® can be used to manage a wound until the treating physician determines that skin grafting is appropriate. Micro-autografts could then be used, ultimately bringing the wound to full closure.” 

“We are excited to partner with ATT to distribute the Xpansion micro-autografting kit, which we believe represents the next generation of skin grafting,” said Patrick A. McBrayer, president and chief executive officer of ACell. “ACell continues to grow its portfolio of wound care technologies in order to offer physicians and their patients a range of clinical options for wound management.”  

WCA Releases Referral Source Algorithm For U.S. Wound Care

In an effort to help its partners increase awareness of their local wound care programs, officials at Wound Care Advantage (WCA) have announced the launch of FlightPlan,™ which is described as the industry’s first referral source algorithm. According to company officials, the technology makes it easier to identify local physicians who are treating patients who may be in need of advanced wound care on a platform that covers the entire country.

“Close to seven million patients are in need of wound care right now, and we know where they are,” said Mike Comer, chief executive officer of WCA. “We’ve developed an advanced algorithm that identifies physicians with patients currently in need of a specialized wound treatment program.”

The beta test for FlightPlan was conducted in three states at several facilities, officials said. Each center reportedly achieved improvement across several key metrics. A comparison of the year-over-year quarter after implementing FlightPlan showed the following:

• 38% average increase in total visits,
• 30% average increase in active physicians, and
• reengagement with physicians in the area who had not referred in more than six months

 “As a busy program director, an important element of my job involves creating a strategic community education plan tailored to our region,” said Melinda McIntosh, RN, program director at Clark Memorial Hospital Wound Healing and Hyperbaric Medicine Center, Jeffersonville, IN. “FlightPlan addresses the time-consuming task of locating physicians in our area with patients who may benefit from our wound care program. It’s truly remarkable.” 

For more details, visit the tool’s website: www.thewca.com/flightplan