WINTER 2013-2014

2 W A M E S O U T L O O K Winter 2013-2014

3Winter 2013-2014 W A M E S O U T L O O K

Table of ContentsWhat’s Happening in the Hospitals Will Effect Future DME Referrals 5-6

Hospital Readmissions 7-8Avoiding penaltiesThe Future of Sleep Medicine is Here 11

What HMES Needs to Know About the Small Business Health Care Tax Credit 13-14

For their next act:CMS Has Another Trick Up Its Sleeve 15

Workers Compensation Cost Control 19-20Leadership 21A coaching approach Performance Improvement Made Simple? 22-23

WAMES 2013 Annual Convention 24-25

Medtrade 2013 26

WAMES Raises Fund for Second Harvest Foodbank of Southern Wisconsin 27

WAMES Board of DirectorsPresident, Jim Spellman,

Home Care Medical, New BerlinVice President, Beau Hoy,

Lincare, Grandview, OHSecretary, Sharon Suchomel, ThedaCare At Home, Appleton

Treasurer, Nick Bach, Lincare, Lake Geneva

Past President, Randy Lutz, ThedaCare At Home, Appleton

Director, Rick Adamich, Oxygen One, WaukeshaDirector, Lori Christel ,

Bay Pharmacy, Sturgeon BayDirector, Victoria Gouldthorp,

Fort Medical Equipment, Fort AtkinsonDirector, Eric Hagen,

HME Home Medical, Green BayDirector, Troy Kerkenbush,

UW Home Care DME, MiddletonDirector, Val Larmer,

Phillips Drug Store, MaustonDirector, Donna Smith,

Home Care Medical, New Berlin

Associate Director, Derek Etjen, VGM Group, Waterloo, IA

StaffExecutive Director

and Outlook Editor, Ann Barrett

Any reproduction or reprint of this guide, or portion thereof, without written permission from the Wisconsin Association of Medical Equipment Services is prohibited. Information is subject to change without notification. Please contact WAMES if you have questions about Outlook content.

WAMES c/o Ann BarrettP.O. Box 389Wild Rose, WI 54984abarrett@uniontel.net715-366-7500 or fax 715-366-4501

Senator Tammy Baldwin has been a tremendous advocate for WAMES

members for many years and is very knowledgeable about the DME industry. She testified in Washington last spring at a hearing about competitive bidding and saved the meeting from going against the DME industry. In the past, she has visited member’s stores and helped with many issues important to them. WAMES presented the WAMES Friend of the Industry Award to Senator Tammy Baldwin at the 2013 Annual Conference in September.

WAMES presents Friend of the Industry Award to Senator Tammy Baldwin

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By Bob Messenger

Like it or not, the Affordable Care Act has stirred the entire healthcare pot. However you slice it, virtually every

component of the healthcare system is being challenged to recreate itself. Largely these challenges are financially driven, for the DME industry it’s National Competitive Bidding, for hospitals it’s reducing 30-day readmissions, and for physicians it’s a matter of improving quality while keeping costs down. As all healthcare providers are assessing how they are going to survive and thrive in this new environment, one thing is clear; that everyone must figure out a way to improve outcomes while being paid less.

What do we mean by outcomes? It all starts with the hospitals. Avoidable hospital readmissions have been singled out as a multi-billion dollar target. Failure of a hospital to reduce their readmissions for specific diseases results in a penalty — a reduction in DRG payment amounts — that is applied the following year. CMS applies this penalty to all DRGs, not just the conditions that are being monitored. Think of it as an audit. Instead of looking at all the possible diagnoses, CMS focuses on just a few DRGs — a representative sample — then applies their findings to the entire spectrum of DRGs.

In this, the second year of the program, the maximum potential penalty is double what it was the first year. Yet amazingly, the average hospital’s actual penalty has gone down. To achieve these goals hospitals have focused on improving a number of aspects of patient care, including;• Improving the acute-stay patient

experience, i.e., better meals, more personable service, etc.

• Providing patients with better education on managing their disease.

• Improving the discharge process by making sure patients have clear, understandable discharge instructions and the resources they need to continue their recovery and remain healthy.

• Most importantly, they are collecting and analyzing data on what works and what doesn’t.

Although it is impossible to predict the future, it seems reasonable to speculate that the information obtained from data has the greatest potential to impact DME businesses. Consider that hospital penalties are based on achieving a target readmission rate and that target is largely based on the national average readmission rate, a rate that will keep going down as hospitals continue to refine their programs. At first, even poorly implemented system changes and programs, where none previously existed, will result in some reduction in readmissions. However, over the long haul unwieldy program implementation will not be enough. Hospitals are acutely aware that their success will be driven by their ability to understand which factors are positively and negatively influencing their outcomes. To do this, they are collecting data, lots and lots of data on everything and anything that can influence readmissions. Like patient demographics, diagnosis, was the patient directly admitted or did they come in through the ER, what floor were they on, who was the managing physician, were they enrolled in a rehab program, did they receive patient education?And that’s just on the inpatient side. Remember, this is a program that measures the ability to keep the patient out of the hospital. Community resources that impact the patient following discharge will also be measured. Nursing homes, home health agencies and, yes, even durable medical equipment providers will be measured.

Before data can be used to help guide care it needs to be gathered in a sufficient quantity so that it can be trusted and used to make objective decisions. Largely that’s where we are today — the information gathering stage. Hospitals are spending huge resources on new data collection

continued on page 6

What’s Happening in the Hospitals Will Effect Future DME Referrals

Bob Messenger is the Manager of Respiratory Education for the Invacare Corporation. Invacare is the world’s leading manufacturer and distributor in the home medical, rehabilitation and respiratory equipment markets. In his tenure with Invacare, Bob has held a variety of positions including Regional Clinical Specialist, Product Manager as well as his current role of Manager of Respiratory Clinical Education.

Messenger is a Registered Respiratory Therapist and a Fellow of the American Association for Respiratory Care. His 30+ year respiratory career includes acute care as well as a variety of post-acute care positions culminating in the operation and ownership of a durable medical equipment and a sleep diagnostics business. He has held educational positions in both the acute care and academic settings, where he continues to serve in an advisory capacity. Bob serves on several peer review editorial boards and his research has resulted in over two dozen publications in trade and peer-reviewed journals and he lectures on a variety of topics throughout North America and Europe.

6 W A M E S O U T L O O K Winter 2013-2014

continued from page 5

systems and on statisticians to help make sense of all the information.

Soon will come the day when hospital administrators will have statistically significant data from which they will identify the best and worst physicians, nursing units, programs, ECFs, HHAs and DMEs. You can bet corrective actions will be taken with the poorest performers in each group and the best performers will likely be rewarded. For the DME provider that could mean anything from elimination from the referral rotation list to formalizing a preferred provider agreement.

Not every hospital will be collecting exactly the same data, and not all will be tracking the impact of DME referrals on outcomes. However, given this uncertainty, it is better to error on the side of assuming that you will be under the microscope, as opposed to finding yourself there and hoping for the best. As they say, hope is not a good strategy. Instead, think about what the hospitals are trying to achieve, which patients they are most focused on, what your involvement is with those patients and what you might be able to do differently to possibly reduce their potential for readmission.

An obvious example is pulse oximetry. Although hard data is lacking, one

study pegs the use of oximeters by DME companies to titrate pulse dose oxygen settings at about 40 percent. It is well recognized that using pulse dose devices set on the setting number that is the same as the continuous liter flow value rarely provides equivalent oxygenation. In fact, patients are frequently under-oxygenated and less stable than on the numerically equivalent continuous flow setting. So consider titrating the setting, both at rest and with activity to ensure that the patients referred to you are adequately oxygenated, more stable and less likely to be readmitted.

Many providers are already taking steps to position themselves favorably. Some are providing oxygen-generating portable equipment and promoting the benefits it may have on improving patient activity. Many of those same providers are taking some of the savings obtained by improving their operational efficiency and using it to expand their patient education to include simple disease management. Remember, you don’t need to develop an extensive program, any activity is better than no activity.

It’s impossible to say whether a specific hospital is tracking outcomes to DME providers, but it seems prudent to assume that they are. It’s better to error on the side of caution, rather than to find yourself on the outside looking in.

Resourcesn Rau J. Armed with bigger fines, Medicare to punish 2,225 hospitals for excess

readmissions. Kaiser Health News. Aug 2, 2013. www. kaiserhealthnews.org/stories/2013/august/02/readmission-penalties-medicare-hospitals-year-two.aspx. Accessed 11/12/2013.

n Scott L. It’s all about the outcomes. Hospitals and Health Networks (published by the American Hospital Association). Dec 2010. www. hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/12DEC2010/1210HHN_Coverstory&domain=HHNMAG. Accessed 11/25/2013.

n Wray K. Data-mining initiatives to improve patient outcomes. Hospital Impact. 2/1/2011. www. hospitalimpact. org/index. php/2011/02/01/first_phase_data_capture_to_inform_clini. Accessed 11/25/2013.

n Executive summary. Reducing hospital readmissions for congestive heart failure. International Business Machines (IBM). White paper 6/2012. www. hospitalimpact. org/index. php/2011/02/01/first_phase_data_capture_to_inform_clini. Accessed 12/3/2013.

n Phillips CJ, Greene JA, Podolsky SH. Moneyball and medicine (editorial). N Engl J Med 2012;367:1581-83.

n Limberg T, et al. , Changes in supplemental oxygen prescription in pulmonary rehabilitation (abstract). Resp Care 2006;51(11):1302.

What do we mean by outcomes? It all starts with the hospitals. Avoidable hospital readmissions have been singled out as a multi-billion dollar target. Failure of a hospital to reduce their readmissions for specific diseases results in a penalty ... Think of it as an audit.

7Winter 2013-2014 W A M E S O U T L O O K

If one is presently employed in the Health Care system in the United States, then you have been greatly affected by

recent Healthcare changes. Hospitals have been scrambling to adjust to new rules and responsibilities that have been thrust upon them. The Hospital Readmission Reduction Program (HRPP) is one of these new adjustments1 where CMS is reducing payments to hospitals that are deemed as having excess readmissions. Original diagnoses targeted starting October of 2012 were Acute Myocardial Infarction (AMI), Heart Failure (HF) and Pneumonia. CMS looked at readmission rates for these diagnoses over a three-year period and compared them to a national rate which was deemed acceptable. And why are hospitals frantic? Because two-thirds of hospitals in the HRRP received penalties in FY 2013. Penalties start at 1 percent for all hospital payments , increasing to 2 percent, and finally to 3 percent in October 2014.

A readmission is defined as a

hospitalization of the patient within 30 days of the original discharge. The readmission is counted even if the patient is admitted for a different condition than the original admission. If a patient is admitted to a different hospital, the original admitting hospital is still the penalized institution. It is no wonder that hospitals are frantically trying to assess the impact of these new rules on their viability.

In Fiscal year 2015, three new diagnoses will be added; patients admitted for elective total hip arthroplasty (TAH), total knee arthroplasty (TKA) and acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). The addition of COPD hits close to home for us Respiratory Therapists and Sleep Techs. We may be called on to try to impact these readmission rates by utilizing our clinical expertise and experience.

COPD is a very challenging disease to treat, since there is no cure and we are trying to treat the symptoms. It is a multi-disciplinary challenge, utilizing

physicians, nurses, respiratory therapists, occupational therapists, physical therapists and dieticians, to try and alleviate the symptoms that COPD patients experience. Healthcare workers that have treated these patients know how frequently they return to the hospital. One study shows 22 percent of Medicare COPD patients will be readmitted to the hospital within 30 days. What can we do as clinicians to reduce this number?

Treating COPD should be a muti-disciplinary approach with many facets of treatment. Probably, number one would be smoking cessation, which may be the most difficult for patients. Other options should include pulmonary rehab, oxygen therapy, bronchodilators, steroids and NIV. If NIV is a viable choice there are a number of key points that practitioners need to be aware of.

Smoking, the major cause of COPD, destroys the structure of the lung, its tissues and the lung’s normal mechanics. Instead of a very elastic diaphragm, that easily

continued on page 8

Hospital ReadmissionsAvoiding penalties

8 W A M E S O U T L O O K Winter 2013-2014

continued from page 7moves up and down with little effort, severe COPD patients are left with a flattened diaphragm that is pushed down by air trapped in the lungs and the possible “barrel chest.” The diaphragm when contracted has no place to go since it is already pushed down. Thus the patient must rely on accessory muscles to breathe, intercostals and the sternocleidomastoid, to try to create space so the lungs can expand. The accessory muscles are not as efficient as a fully functioning diaphragm, and couple that with the accessory muscles being nonfunctional in REM, this may create problems in many COPD patients during sleep. Sleep is no longer a restful state as these patients will hypoventilate, have desaturations, fragmented sleep with arousals and muscle fatigue. In these patients, NIV may be an option to help normalize their sleep.

Should NIV be an option, then the caregiver needs to realize there are particular features on bilevels that are very valuable for COPD patients that may make the difference between the patient being compliant and the machine being a doorstop. This could also make the difference between the patient staying home or being readmitted.

Bilevels are more comfortable for patients to breathe on compared to volume ventilators because they are flow cycled. It takes a small amount of flow to start the breath and the machine then looks at the degradation of flow to know when exhalation should occur. This is ideal in a patient with normal lung mechanics. In patients whose flow rates are compromised, such as a COPD patient, this can be a problem as the flow never degrades enough for exhalation to happen. The goal of therapy in a COPD patient is to give them more time to exhale and to minimize their work of breathing. A COPD patient placed on a bilevel with standard settings may see an increased inspiratory time, giving

them less time to exhale. The opposite of what the therapy goal is. It is important to have a bilevel that the caregiver can adjust the inspiratory time either by time cycling, cutting the breath off quicker, or by adjusting the cycle sensitivity, to ensure ending the inspiratory phase more appropriate to the patient’s needs. One of the reasons patients do not tolerate bilevel therapy is patient/device asynchrony, for COPD patients the caregiver needs to have the flexibility to adjust the cycle.

Another important tool would be that of adjustable flow rate or rise time. Many COPD patients experience air hunger so it is important that the bilevel of choice have the capability to meet a high flow demand of air hungry patients as well as the ability to reduce it for some patients.

Bottom line, if we believe NIV could be a tool to combat readmission rates of COPD patients from acute exacerbations, we need to make sure we understand what is important in getting COPD patients comfortable and compliant on bilevels. Bilevel should not increase the work of breathing but function as “muscle unloading” for the patient. The devices we have today have some very useful features available for this group of patients. We, as caregivers, need to understand what features are available to us and how to utilize them on different patient populations, since treating a COPD patient can be very different than treating an OSA patient.

In the next few years, hospitals will be looking for answers on how to improve their performances, and hopefully they partner with respiratory therapists and sleep techs for guidance in caring for their COPD patients. When we are called upon to positively impact COPD readmission rates we need to make sure we have the tools we need to make a lasting impact.

Gary Hamilton, BS, RRTRegional Clinical Specialist, ResMed Corp

Resourcesn Centers for Medicare & Medicaid Services Affordable Care Act Update: Implementing Medicare Cost Savings.June 2010.

Online at: http://www.cms.gov/apps/docs/aca-update-implementing-medicare-costs-savings.pdfn http://www.kaiserhealthnews.org/Stories/2013/Auugust/02/readmission-penalties-medicare-hospitals-year-two.aspx n Jencks S F, Williams M V, Coleman E A. Rehospitalizations among patients in the Medicare fee-for-service program.New Engl J Med 2009;

360(14):1418-28.

Treating COPD should be a muti-disciplinary approach with many facets of treatment. Probably, number one would be smoking cessation, which may be the most difficult for patients. Other options should include pulmonary rehab, oxygen therapy, bronchodilators, steroids and NIV.

9Winter 2013-2014 W A M E S O U T L O O K

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The adoption of the Affordable Care Act passed by Congress will continue to shift the emphasis toward improving

the outcome of care and reducing costs, possibly by focusing on integration of care among providers and across care settings.

The challenge will be to develop care models that improve the health of the population and decrease the cost of care.

M. Safwan Badr, MD, FAASM, president of the American Academy of Sleep Medicine,

has opined on how the field of sleep medicine might change, within this context.

He noted that the diagnosis and management of obstructive sleep apnea is associated with significant health care expenditure.Private payers have estimated that OSA-related claims expenses will increase anywhere from 20-40% annually.To decrease the direct cause of diagnostic services, many payers have adopted out of center sleep testing (OCST) for the evaluation of patients with suspected OSA.As a result, some private payers have begun to require utilization management review and preauthorization for diagnostic sleep testing, as a cost containment measure.

To ensure consistent high quality, the AASM has implemented a new accreditation program for OCST.More than 1,200 sleep medicine facilities have earned OCST accreditation from the AASM.In addition, the AASM has developed standards for evaluation of national suppliers who provide OCST services for sleep centers - the new approved OCST supplier designation.This arrangement allows the sleep specialist to focus on evaluating the patient, ordering the test, interpreting the results, making the diagnosis, and overseeing all follow-up care for the patient.

The Future of Sleep Medicine is Here

the types of appropriate patient selection and management protocols that were utilized.

Sleep medicine practices will need to be proactive in developing the capability to perform high quality OCST testing.This means conversations with insurers to establish guidelines or care pathways that follow up existing evidence-based clinical guidelines, and provide access to diagnostic and treatment modalities for all patients.Though there will always be a need for in-laboratory testing for patients with particular comorbidities, a smaller number of patients in the foreseeable future, over the next few years, home sleep apnea testing will continue to grow, and may replace polysomnography as the initial diagnostic test for many patients.When this happens, ideally, the right test can be fitted to the right patient in the right setting.

Robert C. Buss, MDMile Bluff Medical Center

The new health care environment is shifting focus toward integrated care and long-term disease management of chronic sleep illness.The challenge before us is to develop models for coordinated care that promote high quality and cost effective care.This will likely involve adopting the approach of the Patient Centered Medical Home (PCMH), the use of clinical registries, and monitoring of health-related outcomes and tools.Badr envisions that future comprehensive models of care will involve a synergistic partnership between primary care physicians and sleep physicians within the framework of a comprehensive, accredited sleep center.

The team could include clinical psychologists, nurse practitioners, physician assistants, sleep technologists, and durable medical equipment providers.Ideally, the care team would interface seamlessly with the primary care physician to ensure delivery of timely, appropriate, high quality and patient-centered care.

Out of center sleep testing (OCST) technology has been around for a long time, but evidence supporting its use has taken time to develop. Practice parameters from the American Academy of Sleep Medicine (AASM) and the American Sleep Disorders Association (the precursor to the AASM) in 1994, 1997, and 2003 found the evidence insufficient to warrant widespread clinical use. It was not until 2007 that sufficient supporting data were published to allow development of clinical guidelines with recommendations for adoption of OCST.

A number of randomized controlled clinical trials have demonstrated that, in the hands of sleep medicine specialists, a home-based portable monitoring strategy for both diagnosis and treatment of patients with moderate to severe OSA (without comorbid medical conditions likely to degrade the accuracy of portable monitoring) is not inferior to a laboratory-based strategy.

A concern with generalizing these studies to broad scale use of OCST is how to maintain

Resourcesn Atwood CW. “The times they are

a changin:” home diagnosis of sleep apnea has arrived. SLEEP 2012;35(6):735-736

n Rosen CL, Auckley D, Benca R, et al. A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: The HomePAP Study. Sleep 2012;35:757-67

n Quan SF; Epstein LJ. A warning shot across the bow: the changing face of sleep medicine. J Clin Sleep Med 2013;9:301-2

n Badr MS. The future is here. J Clin Sleep Med 2013;9(9):841-843

n Epstein L.The Evolution of OCST.2013.

Dr. Robert C. Buss

12 W A M E S O U T L O O K Winter 2013-2014

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What HMES Need to Know About the Small Business Health Care Tax CreditBy Mark HigleyVGM Group, Inc.

A recent GAO study found that only 170,300 small employers from a pool of eligible firms estimated at more

than 1.5 million actually claimed the tax credit. The tax credit, enacted as part of the 2010 Affordable Care Act, is aimed at defraying the high cost of health coverage. It is available to companies that have 25 or fewer workers, pay average salaries of $50,000 or less and cover at least half of employee health insurance premiums.

The total 2010 pool amount of the credit — as estimated by the CBO — was $2 billion, but only $480 million was claimed. Why?? Is your HME business one of these? According to the report, the average credit was $2,700, but many received more than $10,000!

Some small employers reported that they found the tax credit program to be too confusing — and often too costly -- to be worth the accounting endeavor. But many more “just didn’t know about it”…

So let’s review it — in simple terms. And let’s see how many of you missed an opportunity (and it is NOT too late!!)

Who Is Eligible?If your HME business has fewer than 25

full time equivalents, average annual wages of less than $50,000, and you pay at least half of the cost of health insurance for your employees you are eligible for a tax credit.

The full credit is available to employers with 10 or fewer employees and average annual wages of less than $25,000. The credit phases-out as firm size and average wage increases. The credit is capped based on the average health insurance premium in the area where the small business is located. (Details are on the IRS links that will follow.)

Timing and Amount of the Credit

For tax years 2010 through 2013, the maximum credit is 35 percent of premiums paid for small business employers and 25 percent of premiums paid for small tax-exempt employers such as charities.

For tax years beginning in 2014 or later, there will be changes to the credit:

n The maximum credit will increase to 50 percent of premiums paid for small business employers and 35 percent of premiums paid for small tax-exempt employers.

n To be eligible for the credit, a small employer was required to pay premiums on behalf of employees enrolled in a qualified health plan offered through a Small Business Health Options Program (SHOP) Marketplace. BUT…the date has now been pushed back to November 2014 for coverage that takes effect in January 2015.

n The credit will be available to eligible employers for two consecutive taxable years.

Even if you are a small business employer who did not owe tax during the year, you can carry the credit back or forward to other tax years. Also, since the amount of the health insurance premium payments are more than the total credit, eligible small businesses can still claim a business expense deduction for the premiums in excess of the credit. That’s both a credit and a deduction for employee premium payments!

While relatively few operate in the HME industry, small tax-exempt employers also benefit. The credit is refundable, so even if you have no taxable income, you may be eligible to receive the credit as a refund so

continued on page 14

For tax years beginning in 2014 or later, there will be changes to the credit: The maximum credit will increase to 50 percent of premiums paid for small business employers and 35 percent of premiums paid for small tax-exempt employers.

14 W A M E S O U T L O O K Winter 2013-2014

continued from page 13long as it does not exceed your income tax withholding and Medicare tax liability.

And finally, if you can benefit from the credit this year but forgot to claim it on your tax return, there’s still time to file an amended return.

Now that you know how the credit can make a difference for your HME business, let’s determine if you can claim it.

Once more, to be eligible, you must cover at least 50 percent of the cost of single (not family) health care coverage for each of your employees. You must also have fewer than 25 full-time equivalent employees (FTEs). Those employees must have average wages of less than $50,000 (as adjusted for inflation beginning in 2014) per year. Remember, you will have to purchase insurance through the SHOP Marketplace to be eligible for the credit for tax years 2015 and beyond.

You may be wondering “what is the definition of an FTE?” Basically, two half-time workers count as one FTE. That means 20 half-time employees are equivalent to 10 FTEs, which makes the number of FTEs 10, not 20.

Now let’s talk about average annual wages. Say you pay total wages of $464,000 and have 17 equivalent FTEs. To figure average annual wages you divide $464,000 by 17 — the number of FTEs — and the result is your average annual wage. The average annual wage would be about $27,000.

Also, the amount of the credit you receive works on a sliding scale. The smaller the business the bigger the credit. So if you have more than 10 FTEs or if the average wage is more than $25,000 (as adjusted for inflation beginning in 2014), the amount of the credit you receive will be less.

How do you claim the credit?You must use Form 8941 “Credit

for Small Employer Health Insurance Premiums” to calculate the credit. www.irs.gov/pub/irs-pdf/f8941.pdf

For detailed information on filling out this form, see the Instructions for Form 8941 at www.irs.gov/pub/irs-pdf/i8941.pdf

If you are a small business, include the amount as part of the general business credit on your income tax return.

If you are a tax-exempt organization, include the amount on line 44f of the Form 990-T, Exempt Organization Business Income Tax Return. You must file the Form 990-T in order to claim the credit, even if you don’t ordinarily do so.

Don’t forget ... if you are a small business employer, you may be able to carry the credit back or forward. And if you are a tax-exempt employer, you may be eligible for a refundable credit.

Here’s what this means for small HME employers by example...

If you pay $50,000 a year toward workers’ health care premiums — and if you qualify for a 15 percent credit, you save ... $7,500. If, in 2014, you qualify for a slightly larger credit, say 20 percent, your savings go from $7,500 a year to $12,000 a year.

Questions?CONTACT Mark HigleyDirst: 888-224-1631Cell: 319-504-9515Email: mark.higley@vmg.com

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For their next act:

CMS Has Another Trick Up Its Sleeve

As if the challenges with competitive bidding, audits and the new face to face requirement for DME weren’t

enough to keep our heads spinning CMS has yet another trick up its sleeve slated for implementation in 2014.

Medicare reclassification of certain DME codes from purchase to capped rental

On November 22, 2013 CMS posted a final rule that will shift 78 HCPCS codes from first-month purchase option to 13-month capped rental under the Medicare program. The implementation of this rule takes effect on a tiered basis dependent upon whether the particular HCPCS code is included in Round 2 or Round 1 Re-compete of competitive bidding:

n April 1, 2014 is the effective date for items furnished in all areas of the country if the item is not included in either round of national competitive bidding;

n July 1, 2016, is the effective date for items furnished in all areas of the country if the item is included in a Round 2 bid area and not in a Round 1 Re-compete and for items included in Round 1 Re-compete but furnished in an area other than one of the 9 Round 1 Re-compete areas; and

n January 1, 2017 is the effective date for items included in a Round 1 Re-compete and furnished in one of the 9 Round 1 Re-compete areas.

At this time there are more questions than answers pertaining to the administration of this rule. AA Homecare and NCART are both working diligently

to obtain answers from CMS. There were 172 public comments submitted on this proposed rule back in August which CMS largely ignored even though many of the comments were extremely valid points.

The most glaring concerns with this rule are as follows:

n The inclusion of the adult manual tilt in space code (E1161).

n Motor and gearbox replacements being paid on a capped rental basis.

n For repair services, will the wheelchair base being repaired determine whether the repair will be paid as a purchase or a rental.

n The trickle-down effect to other funding sources.

One thing important to keep in mind is if a particular accessory identified by a HCPCS code in the list below is provided for use on a complex rehab power wheelchair (K0835-K0864), the accessory will maintain the purchase option. This abbreviated list of 50 codes/accessories only shows the items that impact wheelchairs, the remaining 28 codes have little or no impact on the mobility market. As noted in the comments, there are a large number of items (i.e. powered seating systems, high end driver controls) that will only ever be provided with complex rehab power wheelchairs so there should not be much impact on these items. This list also provides effective dates to help easily identify when each code goes into effect.

Jim Stephenson is the Rehab Reimbursement Manager at Invacare Corporation based in Elyria, Ohio. He can be reached for questions at jstephenson@invacare.com

See schedule of reclassification of DME codes on the following page

16 W A M E S O U T L O O K Winter 2013-2014

CODE DESCRIPTION EFFECTIVE COMMENTSE0955 Cushioned headrest 2016/2017 Can be provided with CRTE0985 WC seat lift mechanism 2016/2017 Typically not CRTE0986 MWC push-rim power assist 4/1/2014 CRT but still capped rentalE1002 Power seat tilt 4/1/2014 Only provided with CRTE1003 Power seat recline 4/1/2014 Only provided with CRTE1004 Power seat recline mechanical shear 4/1/2014 Only provided with CRTE1005 Power seat recline power shear 4/1/2014 Only provided with CRTE1006 Power seat combo w/o shear 4/1/2014 Only provided with CRTE1007 Power seat combo w/shear 4/1/2014 Only provided with CRTE1008 Power seat combo power shear 4/1/2014 Only provided with CRTE1010 Add power leg elevation 4/1/2014 Can be provided with CRTE1014 Reclining back add pediatric WC 4/1/2014 Can be provided with CRTE1020 Residual limb support system 2016/2017 Can be provided with CRTE1028 WC manual swingaway hardware 2016/2017 Can be provided with CRTE1029 WC vent tray fixed 4/1/2014 Only provided with CRTE1030 WC vent tray gimbaled 4/1/2014 Only provided with CRTE1161 Manual adult WC with tilt in space 4/1/2014 CRT but still capped rentalE1232 Folding pediatric WC tilt in space 4/1/2014 CRT but still capped rentalE1233 Rigid pediatric WC tilt in space w/o seat 4/1/2014 CRT but still capped rentalE1234 Folding pediatric WC tilt in space w/o seat 4/1/2014 CRT but still capped rentalE1235 Rigid pediatric WC adjustable 4/1/2014 CRT but still capped rentalE1236 Folding pediatric WC adjustable 4/1/2014 CRT but still capped rentalE1237 Rigid pediatric WC adjustable w/o seat 4/1/2014 CRT but still capped rentalE1238 Folding pediatric WC adjustable w/o seat 4/1/2014 CRT but still capped rentalE2227 Gear reduction drive wheel 4/1/2014 Can be provided with CRTE2228 MWC accessory, wheelchair brake 2016/2017 Can be provided with CRTE2310 Electronic connect between controls 4/1/2014 Only provided with CRTE2311 Electronic connect between 2 systems 4/1/2014 Only provided with CRTE2312 Mini-proportional remote joystick 4/1/2014 Can be provided with CRTE2313 PWC harness, expand control 4/1/2014 Only provided with CRTE2321 Hand interface joystick 4/1/2014 Can be provided with CRTE2322 Multiple mechanical switches 4/1/2014 Can be provided with CRTE2325 Sip and puff interface 4/1/2014 Only provided with CRTE2326 Breath tube kit 4/1/2014 Only provided with CRTE2327 Head control interface mechanical 4/1/2014 Only provided with CRTE2328 Head/extremity control interface 4/1/2014 Only provided with CRTE2329 Head control interface non-proportional 4/1/2014 Only provided with CRTE2330 Head control proximity switch 4/1/2014 Only provided with CRTE2351 Electronic SGD interface 4/1/2014 Can be provided with CRTE2368 PWC drive wheel motor replace 2016/2017 Can be provided with CRTE2369 PWC drive wheel gear box replace 2016/2017 Can be provided with CRTE2370 PWC drive wheel motor/gear comb 2016/2017 Can be provided with CRTE2373 Hand/chin control spec joystick 4/1/2014 Can be provided with CRTE2374 Standard joystick replacement 4/1/2014 Can be provided with CRTE2375 Non-expandable controller replacement 2016/2017 Can be provided with CRTE2376 Expandable controller, replacement 4/1/2014 Only provided with CRTE2377 Expandable controller, initial delivery 4/1/2014 Only provided with CRTE2378 Power actuator replacement 4/1/2014 Can be provided with CRTK0015 Detach non-adjustable height armrest 2016/2017 Can be provided with CRTK0070 Rear wheel complete pneumatic tire 2016/2017 Can be provided with CRT

Medicare reclassification of certain DME codes from purchase to capped rental

17Winter 2013-2014 W A M E S O U T L O O K

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19Winter 2013-2014 W A M E S O U T L O O K

By Mike WarrenPharmacists Mutual Companies

As with any other sudden or unexpected event that may occur to an organization, an employee injury

impacts the bottom line. Production or delivery schedules are affected, customer service is impacted and administrative time and expense can be significant. Whether you pay directly or through insurance premiums, costs can go up.

Unfortunately, employee injuries can also be complex and difficult to manage. Handling it the wrong way can significantly increase costs.

Here are some ideas for keeping your workers compensation costs in check.

Provide a safe workplaceYou can’t calculate the cost of injuries

that did not occur because the aisles were clear, but you can when a serious trip and fall injury happens.

Organizations that control employee injury costs integrate safety into the way they do business. When they purchase new equipment, they consider how it will impact safety. When they experience injuries, they learn and make changes. When they implement safety related controls, management supports their actions on a day to day basis.

Educate before an injury occurs

Chances are, when someone is injured it is their first experience with the world of workers compensation. Many fear they will lose their job and have no idea how medical bills will be paid or what they can expect. These fears are often fed by friends and family who may have had bad experiences. When these fears go unresolved, employees may take advice from others or seek assistance from an attorney. When it reaches this point, you may no longer be able to communicate with the employee, and the cost and complexity of any claim

may grow significantly. Check with your insurance company or

the state department of insurance to obtain educational materials about the workers compensation system. Remember, if you don’t tell your employees about workers compensation, someone else will.

Get medical careFirst and foremost, make sure the

employee receives medical care if needed. In an emergency, the nearest medical facility is generally the best choice. In Wisconsin, the employee has a choice of providers, but the employer can direct that they see a physician if they feel it is necessary. The best recommendation is generally to err on the side of caution.

Gather the facts, just the facts... then investigate

In situations where the injury is beyond routine first aid, an Employers First Report of Injury must be completed. Beyond legal requirements, the first report allows your insurance company to begin monitoring and if necessary managing treatment received.

Before making any conclusions about what caused in injury, gather the facts

One of the biggest errors made by employers is to immediately assume the cause and jump to conclusions. Overwhelmingly, the most frequent “cause” found on accident and injury reports is along the lines of “the employee was careless.” Unfortunately, investigation and follow-up often stop as soon as this conclusion is made. The reality is that the employer actually controls most of the factors that were likely involved in an injury occurrence. The employer hires, trains and supervises employees, they select the equipment they work with, materials they handle or deliver and procedures they follow.

continued on page 20

Workers Compensation Cost ControlEmployee injury can be complex and difficult to manage. Handling it the wrong way can significantly increase costs.

20 W A M E S O U T L O O K Winter 2013-2014

continued from page 19

Identify causal factorsPEOPLE — Job understanding, physical ability to do the work, training and supervision.

EQUIPMENT — Material handling equipment used to perform the task. Vehicles, handling equipment configuration and condition.

MATERIALS — Objects or people that may need to be handled, chemicals and other objects inside the vehicle, warehouse or patient home.

ENVIRONMENT — Weather and conditions where the work is done, including the patient’s home.

Implement Corrective Action — Priorities Recognize that while some solutions will be obvious, there may

not be any “silver bullets” for some problems. Showing a video does not eliminate the potential for strains and sprains, wearing back-belts may create new problems, signage telling workers to drive carefully won’t by itself prevent collisions.

n Eliminate or transfer the exposure. The most effective correction is to eliminate the exposure or transfer it to another party or company. If you don’t sell powered lift chairs, people can’t get hurt moving them. While the most effective control, this is also the one that is usually not feasible.

n Engineer the problem out. Engineering provides the second most effective control. It involves selection of things like material handling equipment or vehicles, or potentially making adaptations to the product being handled.

n Apply administrative controls. All other controls fall under “administrative controls.” These include employee screening and selection, training, supervision, procedures, rules and other requirements.

Stay in touch and keep the employee connected to the workplace

Unless limited by an employee’s attorney, stay in touch. Occasional phone calls, cards or e-mails can make a world of difference in keeping them connected to the workplace and increasing the possibility of return.

Facilitate return to work whenever possibleThe rule of thumb is that the longer a person is away from work

the less likely it is that they will return to productive employment. Statistically, people who have been injured on the job and away from work for 2 years or more have less than a 5-percent chance of returning.

If possible, work with your insurance company to provide transitional or restricted duty until the employee is fully recovered. Staying active helps the recovery process. Returning employees to work as soon as it is medically safe plays a significant role in controlling costs.

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21Winter 2013-2014 W A M E S O U T L O O K

By Miriam LieberLieber Consulting Associates

In a recent Washington Post article on leadership, James G. Clawson writes as follows: “I think leadership is about

managing energy, first in yourself and then in those around you. What this

definition implies is that unless you are deeply committed to an outcome that others can engage in and understand, no amount of teaching will make you a leader.”

Leader and CoachWhat Clawson writes resonates in what

I see at the HME companies with which I visit. Finding leaders, not just subject experts, is a challenge. Leaders need not only that expertise, but also the internal energy, drive and commitment needed to motivate others in the company. Secondly, even if they have it internally, teaching others adequately is not a given. Rather, some people are terrific at accomplishing their own goals but they are not great teachers and cannot guide the team to meet their goals. In the most successful companies, managers who lead and teach and coach towards a common goal are the ones who get the staff’s buy-in and desire to achieve. The coaching is critical because the more open the communication, the more apt the staff is to achieve.

Staff Buy-InSo what are the traits these successful

leaders possess? Leaders who engage staff in developing goals and objectives are often more successful than those that design the goals themselves and dictate the

LeadershipA coaching approach

requirements. The key is to get buy-in from employees and to make them feel pride of ownership. No doubt, presentation is the key to these and other desired results. Employees who feel like they are part of the decision making process often tend to behave more like owners. Of course, this is not always the case but it is much more likely if you include staff in goal setting.

Checking InBy checking in with staff regularly, you

not only know how they are progressing but you will know when they need help. Many times, employees are afraid to admit when they don’t understand something, especially if they feel they should already know the answer. Some do not know where to turn next or feel overwhelmed and need you to help them prioritize. Additionally, by spending time with staff, you are showing them they are valued. For some, this regular “rounding” is done as a group and for others, it is an individual meeting with each staff member (larger companies divide this by department leaders). Finally, some providers will actually have a daily 5- to 10-minute huddle as well as a monthly or weekly “rounding” with individual staff.

Role ModelingIt is clear from observing and assessing

more than 400 HME companies that employees emulate their bosses and the leaders in the organization. If the boss routinely shows up late, staff begins to do the same. If the leaders embrace the new software, the employees are more apt to use the system. Recently, one staff member at a company I was visiting stopped me on my way out one evening. He wanted me to know that ever since his boss started working 8-to-5 (rather than coming in at 10 a.m. and leaving at 3 or 4 p.m. as he had been doing for the previous year), staff

morale had improved. The more he helped out with the staff, the more the staff was motivated to perform. His behavior became the impetus for improved productivity throughout the company. All in all, this translated into a significant amount of extra cash from his and the employees’ efforts. The take-away from this one minute exchange was that role modeling behavior you want to see in others is more important that one might imagine. For this HME company, it was like walking into a completely different organization, a much better place to work for all involved.

Although you will first need to find the energy and motivation from within, as Clawson writes, once you adopt the credo of engagement by employees and leadership, you should find yourself with a whole slew of owner-mentality workers. With this, and proper goal setting and coaching, your organization will be poised to not only make it through these challenging times but you will likely come out of this shining and prospering beyond your expectations. At a minimum, you will find the real winners in your company and use them to help pave the way as a more fortified, engaged and committed business.

It is clear from observing and assessing more than 400 HME companies that employees emulate their bosses and the leaders in the organization. If the boss routinely shows up late, staff begins to do the same.

Miriam Lieber

22 W A M E S O U T L O O K Winter 2013-2014

Statistical data would tell us that QI/PI is anything but simple. In fact QI/PI continues to be among the most

commonly missed accreditation standards. By following the steps detailed below, you can minimize your PI confusion and maximize the organizational benefits from your efforts.

General PI/QI Principles; n KIS (Keep it simple and specifically

focused to your organization)n Know what you want to get out of it

(CMS compliance only or more?)n Pick a place to store data (makes it easier

to review)n Pick a time each month to review (Set a

date on your calendar) n Develop a plan to address any identified

negative trends (Trends are what we are looking for)

n Document activities

Purpose of PI/QIn Because CMS tells you to! (Since you

have no choice lets add some value!)n QI/PI will enable the organization to

assess processes of care, services and operations.

n Organizational-wide performance improvement efforts address priorities for improved quality of care/service, client/patient/staff safety, operational efficiencies, and regulatory compliance.

Required Study Indicators (You need to select one ongoing PI/QI study indicator for each of these listed categories; total of 7)n Adverse eventsn Client/patient complaintsn Client/patient recordsn Satisfaction surveys n Billing and coding errorsn At least one important aspect related to

service/care provided

Performance Improvement Made Simple?

n On going monitoring of processes that involve risks including infections and communicable diseases, if applicable

Each performance improvement activity/study listed above needs to include the following items: n A description of indicator(s) to be

monitored/activities to be conductedn Frequency of activitiesn Designation of who is responsible for

conducting the activitiesn Methods of data collectionn Acceptable limits for findingsn Who will receive the reportsn Plans to re-evaluate if findings fail to

meet acceptable limits n Any other activities required under state

or federal laws or regulations

Let’s look at an example of a PI/QI study indicator;Study Indicator; Client/patient records n A description of indicator(s) to be

monitored/activities to be conducted (Audit of Client records looking of completeness and accuracy of documentation)

n Frequency of activities (Monthly audit)n Designation of who is responsible for

conducting the activities (Manger and biller)

n Methods of data collection (Random selection of high risk and High volume items. Minimum of 10 charts per product cat)

n Acceptable limits for findings (90 percent)n Who will receive the reports (Owner)n Plans to re-evaluate if findings fail to

meet acceptable limits (Plan of correction to be completed and implemented immediately.Effectiveness of POC will be monitored for 3 months)

n Any other activities required under state or federal laws or regulations (None required)

23Winter 2013-2014 W A M E S O U T L O O K

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Make a Form to use each month and compile your activities:

n A description of indicator(s) to be monitored/activities to be conducted; _________ ___

n Frequency of activities ________________________ ________________________________

n Designation of who is responsible for conducting the activities _____________________

n Methods of data collection ____________________________________________________

n Acceptable limits for findings __________________________________________________

n Who will receive the reports ___________________________________________________

n Plans to re-evaluate if findings fail to meet acceptable limits ________________________

n Any other activities required under state or federal laws or regulations ______________

n Plan of Correction: ___________________________________________________________

Keep it in a Three Ring Binder

n Tab each section for each study indicator (1-7)

n Use the binder to collect data throughout the month

n Use your form to summarize your findings

n Keep Plans of correction in the same section

n Annually summarize all findings for the year

Now when your surveyor shows up for your survey and asks for your three years of PI/

QI data, (yes we will), you have it all organized and in one place.

Very impressive to your surveyor. Remember; KIS (Keep it simple and focused on what

is important to your organization)

24 W A M E S O U T L O O K Winter 2013-2014

By Val Larmer, Conference Chair and Ann Barrett, Executive Director

The Wisconsin Association of Medical Equipment Services presented the 30th annual convention and trade show at

the Kalahari Resort in Wisconsin Dells in September with record attendance of just more than 190 participants.

For the second year, the conference committee incorporated a community service fundraiser that benefited the Second Harvest Foodbank of Southern Wisconsin. WMTV NBS 15 joined WAMES in promoting the “WAMES Golf Scramble: Drive to End Hunger” at Trappers Turn Golf Course. This scramble was open to the public to help raise money, the golf course provided donations and there were even opportunities to win a car or a trip from the Dave Schulz Car Dealership on a hole in one.

At the conference, attendees had their choice of three different educational tracks: Operations, Rehab and Respiratory, and most sessions provided CEUs and CRCEs. Some of the presentations were: “Creating Efficiencies in Today’s Tumultuous Climate” presented by Miriam Lieber, “Overcoming PMD Audits: Keys to Understanding, Responding and Coming out Ahead” presented by Jim Stephenson, and “Oral Appliance Therapy in Sleep Medicine” presented by Robert C. Buss, MD. New this year one evening was a fun Bowling party at the Indoor Theme Park at the Kalahari Resort.

Attendees also had dedicated time to meet with associate members and exhibitors to learn about new products and services. This time is always valuable to participants to have the opportunity to see so many exhibitors at one time in one location. We greatly appreciate the support of our exhibitors. A special thank you goes to our sponsors who helped us deliver a quality

educational conference by providing speakers, resources and donations:n Invacare Corporationn Pride Mobilityn The MED Groupn Philips Respironicsn ResMedn Strategic ARn VGM Groupn Brightreen Golden Technologiesn UW Healthn Pharmacists Mutual Insurance

Companiesn HP Enterprise Servicesn Drive Medicaln ACHCn Covidienn Universal Software Solutions

WAMES gives awards each year to recognize those who have contributed time, expertise and resources to support this association and the industry.

2013 WAMES Awards were presented as follows:n HME Provider of the Year — Home Care

Medicaln Associate Member of the Year — VGM

Groupn Lifetime Achievement Award —

Dennis Ilesn Outstanding Contribution Awards —

Sharon Suchomel, ThedaCare At Home and Dave Hanson, Mercy Assisted Care

n Friend of the Industry — Senator Tammy Baldwin, Representative Paul Ryan and Representative James Sensenbrenner

n Exceptional Service Awards — Eric Hagen, HME Medical and Troy Kerkenbush, UW Health

n President’s Award — Jim Spellman, Home Care Medical

n Industry Excellence Awards — American Association for Homecare, Knueppel HealthCare Services, Home Care Medical, VGM Group and Jean McAdams, Community HME.

WAMES 2013 Annual Convention

Conference attendees had their choice of three different educational tracks: Operations, Rehab and Respiratory, and most sessions provided CEUs and CRCEs.

Dennis Iles received the Lifetime Achievement Award.

Sharon Suchomel was awarded the Outstanding Contribution Award.

25Winter 2013-2014 W A M E S O U T L O O K

We also recognized the board members who finished their term on the board with Distinguished Service awards:n Randy Lutz, Presidentn Beau Hoy, Vice Presidentn Jean McAdams, Past Presidentn Rob Clear, Associate Directorn Dennis Iles, Directorn Tom Voegele, Directorn Jim Spellman, Director

Their time and dedication is greatly appreciated. The board meets either in person or via conference call once a month

and works hard to interpret, inform and influence issues important to members. They and the committees also work in between those monthly meetings to accomplish the goals set in the strategic plan.

Newly elected board members for 2014 were Jim Spellman with Home Care Medical as President, Beau Hoy with Lincare as Vice President and new Directors are Rick Adamich with Oxygen One, Lori Christel with Bay Pharmacy, Derek Etjen with VGM Group and Vicky Gouldthorp with Fort Medical Equipment.

Thank you to the conference committee

who worked so hard to make this event a success:n Jean McAdamsn Troy Kerkenbushn Val Larmern Donna Smithn Eric Hagenn Barb O’Leary

Mark your calendars for the 2014 WAMES Annual Conference & Trade Show again at the Kalahari Resort and Trappers Turn in Wisconsin Dells, Sept. 22-24.

Eric Hagen was presented with the Exceptional Service Award.

Industry Excellence Award presented to Cindy Ciardo.Industry Excellence Award presented to Jean McAdams.

Jim Spellman receives President’s Award. Todd Crouch accepts the Industry Excellence Award for Senator Tammy Baldwin.

26 W A M E S O U T L O O K Winter 2013-2014

Randy Lutz and Ann Barrett attended Medtrade last fall and determined it was very productive though noted a

smaller attendance than in previous years. There was a focus on competitive bidding and how to retool a provider’s business as well as educational sessions on improving retail cash sales with excellent speakers.

WAMES had a booth in the State Association Pavilion with the American Association for Homecare and Ann met with other Executive Directors and discussed a variety of association topics including affinity programs, speakers, individual MA programs, and the variety of members some have. She attended the State Leaders meeting that AAHomecare

Medtrade 2013conducted in addition to the monthly calls WAMES participates in. HR 1717 was the focus of discussion. All are working to ask those who have signed on to convince their peers to do the same and to encourage sharing patient stories. A provider in a Round 1 competitive bid area stated it hits hard financially in approximately six months and more so in a year.

Ann also met with RESNA and NRRTS representatives to discuss educational programs, and the Associate Editor with HomeCare magazine and with Shelly Prial, HME Expert and Medtrade Ambassador who has been a huge advocate of state associations for many years.

Medtrade SpringMarch 10-12, 2014Mandalay Bay Convention Center Las Vegas, NV

MedtradeOct. 20-23, 2014Georgia World Congress Center Atlanta, GA

27Winter 2013-2014 W A M E S O U T L O O K

The “WAMES Golf Scramble: Drive to End Hunger” was held in conjunction with the Annual Conference to raise

funds to benefit the Second Harvest Foodbank of Southern Wisconsin. NBC 15 and anchor John Stofflet helped promote the event and participated in the outing by taping an interview with Jean McAdams and Randy Lutz from the course and by emceeing the golfers reception.

This food drive raised more than $1,000 and made Second Harvest’s October Top 5 Food/Fund Drives list, ranking second by providing 3,150 meals. “If our contribution helps one family, we have made a difference,” said Donna Smith, WAMES Board of Directors.

WAMES board members Troy Kerkenbush and Jean McAdams presented

WAMES Raises Funds for Second Harvest Foodbank of Southern Wisconsin

the donation at the offices of Second Harvest Foodbank.

Second Harvest Foodbank of Southern Wisconsin, southwestern Wisconsin’s largest hunger relief organization, is a non-profit organization that is committed to ending hunger in 16 southwestern Wisconsin counties through community partnerships. By focusing on a multi-pronged approach that includes food distribution, increasing participation in public and private food programs, and mobilizing the public, it serves nearly 141,000 people who struggle with hunger each year; 43 percent of whom are children. It is one of 200 members of Feeding America, the nation’s leading domestic hunger-relief charity. For more information, visit SecondHarvestMadison.org.

Left to right: John Stofflet from NBC 15, Jean McAdams, Anna Nelson with Second Harvest, Troy Kerkenbush and Dan Stein

with Second Harvest

28 W A M E S O U T L O O K Winter 2013-2014

WAMES c/o Ann BarrettP.O. Box 389Wild Rose, WI 54984abarrett@uniontel.net715-366-7500 or fax 715-366-4501

* ACU-Serve Corp., John Stalnaker . . . . . . . . . . . . . . . . . . . . 330-923-5258* Adaptive Engineering Lab, Lindsay Koerner. . . . . . . . . . . . 414-265-7630* Airgas , Ty Schmitz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414-588-8555* Bemis Manufacturing Company, Scott Thomson . . . . . . . 920-467-5465* Brightree, LLC, Vicki Brown. . . . . . . . . . . . . . . . . . . . . . . . . . 678-243-1800* BSN Medical, Tom Kastory . . . . . . . . . . . . . . . . . . . . . . . . . . 414-841-4157* Comfort Company, Colin Thorpe . . . . . . . . . . . . . . . . . . . . . . .800.564.9248* CPR+, Ryan Young . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866-277-4876* DOCS, LLC, Pam Darling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 920-694-0273* Dr. Comfort, Sharon Felber. . . . . . . . . . . . . . . . . . . . . . . . . . . 800-556-5572* Fisher & Paykel Healthcare, Bryan Matye . . . . . . . . . . . . . 414-350-9377* Golden Technologies, John Smid . . . . . . . . . . . . . . . . . . . . . 800-624-6374** Healthstar Associates, Inc., Barry Petrigala . . . . . . . . . . . 847-673-9999* HP, Lori Hock. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 920-634-6450* HQAA, Gabriel Nicholas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866-490-7980** Invacare Corporation, Jason Suhr . . . . . . . . . . . . . . . . . . . . 800-333-6900* Lake Court Medical, Dan O’Neill. . . . . . . . . . . . . . . . . . . . . . 586-771-3100* LifeGas , Jim Fout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 920-924-5719

* Medical Alliances, Inc, Bill Strange. . . . . . . . . . . . . . . . . . . 952-470-5269* Medline Healthcare, Keith Walsh. . . . . . . . . . . . . . . . . . . . . 800-Medline* MK Battery, Lilia Flores. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-372-9253* Pharmacists Mutual Companies, Laurie Harms. . . . . . . . . 515-295-7490** Philips Respironics, Barb O’Leary . . . . . . . . . . . . . . . . . . . . 414-267-7696* Pride Mobility, Beth Plaisance-Hill. . . . . . . . . . . . . . . . . . . . 570-883-4163* R.A. Faber & Associates Medical Marketing, Bob Faber. 847-894-8500 * ResMed, Monte Koenig . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414-305-1192* Sunrise Medical, Jeff Smith, ATP . . . . . . . . . . . . . . . . . . . . . 262-353-8700 * The Compliance Team, Inc., Rick Canally . . . . . . . . . . . . . . 215-654-9110* The MED Group, Rob Clear . . . . . . . . . . . . . . . . . . . . . . . . . . 405-250-9054 The van Halem Group, LLC, Wayne van Halem, CFE, AHFI . . . 404-343-1815* Truform-OTC-PCP-Champion division of

SAI Therapeutic Brands, Mike Anderson . . . . . . . . . . . . 513-271-4594** VGM Group, Derek Etjen . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-642-6065

** indicates WAMES Gold Associate Member* indicates WAMES Silver Associate Member

WAMES 2013 Associate MembersThank you for your support of WAMES