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Archive - March 2007 Posted Mar-20-07 08:46:54 PDT By Matthew Perrone
WASHINGTON – Perhaps no health insurer has more to lose than Humana as Congress considers cutting payments to private companies that run Medicare plans.
While many major insurance companies participate in Medicare Advantage, the privately-run component of the government health plan for seniors, Louisville, Ky.-based Humana Inc. makes nearly half its earnings through the program, according to Prudential Equity Group. By comparison, competitors Aetna Inc. and UnitedHealth Inc. make just 3 percent and 13 percent, respectively, of their profits through their Medicare Advantage plans.
A House subcommittee meets Wednesday to look at how much the government spends to insure senior citizens in Medicare Advantage compared with those in traditional government-run Medicare. Of the 43 million Americans covered by Medicare, about 8 million, or 19 percent, receive their benefits through private company plans.
Ways and Means Health Subcommittee Chairman Pete Stark, D-Calif., and other Democrats with oversight of the program have already made it clear they think insurance companies are overpaid.
“Managed care plans originally came into Medicare saying they could do more for less,” Stark said. “Now that they're in the program, they have changed their tune and are demanding we continue to overpay them to provide their services. That makes no sense.”
Democrats are struggling to make good on a promise to balance the budget, even as they attempt to expand funding for several federal programs, including one that provides health insurance for poor children.
Medicare Advantage plans became a prime target for savings earlier this month when a nonpartisan group that advises Congress on Medicare reported the government spends 12 percent more to provide care for beneficiaries in private plans than in traditional Medicare. The advisory group recommended Congress lower payments to companies like Humana and UnitedHealth to make them equal with regular Medicare spending, a measure that would save $65 billion over five years, according to the Congressional Budget Office.
While reforming the Medicare Advantage program is not the top priority for Democrats this year, most policy analysts agree it will be an important issue and that the risk of cuts is significant.
Humana declined to comment for this story, but its lobbying group, America's Health Insurance Plans, is vigorously defending Medicare Advantage plans, saying they offer more benefits, like dental and vision coverage, as well as lower out-of-pocket expenses.
“Within the beltway it's very easy to talk about policy and numbers on a page,” said Mohit Ghose, the group's spokesman. “But when you listen to Medicare beneficiaries out in the field, as many congressmen will be doing as we head into the budget process, you will hear from them just how much relief these plans provide for them.”
Ghose's group recently spotlighted a report showing that Medicare Advantage plans are favored by constituencies close to the Democratic party: low income and minority seniors.
Medicare officials could not confirm the report's findings, but acknowledged that 57 percent of Medicare Advantage enrollees have incomes between $10,000 and $30,000, compared with 46 percent of those in the government plan.
The controversy over Medicare Advantage is getting attention on Wall Street. Earlier this month Jefferies & Co. analyst Brian Wright downgraded Humana Inc. and WellCare Health Plans Inc. to “hold” from “buy,” saying negative scrutiny from Congress could hurt growth for both companies. Prudential analyst David Shove recommended that “investors stay away from heavy Medicare Advantage contractors like Humana and stick with heavy commercial players like Cigna.”
Shares of Humana rose 63 cents on Monday, or 1.1 percent, to close at $58.86 on the New York Stock Exchange, where the stock has traded between $41.08 and $68.24 over the past 52 weeks.
Part of the reason Humana is uniquely vulnerable to Medicare cuts is that it recently expanded its investment in a plan type called private fee-for-service. Congressional advisers report these plans cost the government 19 percent more than traditional Medicare and are a leading contributor to the escalating costs of the program.
One reason for those heightened costs is that unlike other types of managed care plans– such as health maintenance organizations– private fee-for-service plans are not designed to control medical spending and eliminate unnecessary care.
So what triggered the explosive growth of these plans? Ironically, the same legislative body which is now looking for ways to slow their growth. In 2003, a then Republican-controlled Congress aiming to expand Medicare Advantage offerings changed the government's payment policy to encourage companies like Humana to set up more private fee-for-service plans.
According to Jon Blum, vice president with consultant Avalere Health, the debate over whether Medicare Advantage's primary purpose is to provide extra benefits for seniors or cost savings for government is mainly a result of divisions within Congress itself.
“The difficulty with Medicare Advantage has always been that there are a lot of different constituencies trying to accomplish conflicting goals through the same program all at the same time,” Blum said. “Until there's a clear policy definition of what the program should be, you're going to continue to see these conflicting goals.” Posted Mar-20-07 08:40:16 PDT Van with wheelchair-bound passenger slides into pond
March 19, 2007
SANDOWN, N.H. --A van carrying a wheelchair-bound passenger flipped on its side about 70 feet across an icy pond on Monday, trapping the passenger inside.
Rescuers responded in time to the accident, which happened about 5 p.m. Officials said the icy surface likely kept the van from seeping deep into the water. An ice rescue sled came to the aid of the female passenger, who suffered some bruises. Rescuers also were able to pull the van ashore.
The driver, the only other person inside the van, was taking the woman to an assisted living facility. The driver was not hurt.
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Information from: WMUR-TV, http://www.thewmurchannel.com/index.html
© Copyright 2007 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. Posted Mar-20-07 08:35:38 PDT A lawsuit over hundreds of phone calls to the family of a deceased woman demanding a rented wheelchair be returned has been allowed to resume.
Reginald Nairon, a retired Brentwood pharmacist, sued Holland Medical Equipment in Nashville in 1999 for making hundreds of harassing phone calls and issuing threats in an attempt to get back the rental wheelchair that had been used by his mother before she died.
Joel Holland, a co-owner of the company, denied the allegations through his attorney.
The lawsuit alleges that Holland left messages on the answering machine of a Nairon relative.
According to Nairon, one message said: "You've opened up a nightmare that you won't even believe. You can't believe just how literally crazy I am. I'm coming after you, bud. Find my wheelchair and arrange to get it back to me or you've got a nightmare."
Another message said: "If you want me off your back then return my wheelchair. I'll make things very uncomfortable until you return my equipment to me."
Former Williamson County Circuit Court Judge Russ Heldman had dismissed the case, but the Tennessee Court of Appeals ruled recently that a jury could find the defendant's conduct was "intentional and reckless" and could have resulted in "serious mental injury."
Nairon, who said he did not know where the wheelchair was, said Holland began calling to try to recover the wheelchair in October 1998.
"We have denied the allegations from the beginning and we continue to deny them and are looking forward to winning the case in the courtroom," said Holland's attorney Katherine A. Austin.
Nairon said he received hundreds of calls over the course of several months.
Posted Mar-16-07 07:14:06 PDT IRVINE, CA -- (MARKET WIRE) -- 03/14/07 -- Free Wheelchair Mission and Reader's Digest are partnering to sponsor the first ever Ride for Mobility. Don Schoendorfer and Dr. Mike Bayer, co-founders of Free Wheelchair Mission, will be undertaking a 3,000-mile cross-country cycling trek to provide the transforming gift of mobility to the physically disabled poor in developing countries.
Entitled Ride for Mobility, the grassroots educational and fundraising campaign was developed to help spread Free Wheelchair Mission's message throughout the country and to raise funds to purchase 15,000 wheelchairs -- designed and manufactured by Free Wheelchair Mission and delivered all over the world for under $50 per wheelchair. Currently, Free Wheelchair Mission has delivered more than 200,000 wheelchairs in over 65 countries throughout the world.
"Currently there are over 100 million people in the world who are in need of a wheelchair," said Don Schoendorfer. "We're launching Ride for Mobility to help raise enough funds to distribute 15,000 wheelchairs to disabled people in developing countries who do not have the resources and are often times subject to having to crawl on the ground in dangerous and unsanitary conditions."
For the important work he is doing through the Free Wheelchair Mission, Don Schoendorfer was featured as a Reader's Digest Everday Hero. The journey kicks off at Reader's Digest's headquarters in Pleasantville, New York on Friday, April 20, 2007. During the campaign, individuals interested in following the trek can log on to the Reader's Digest web site, www.rd.com, to view daily streaming video and/or purchase a subscription to the publication -- as a portion of the proceeds will be donated to Free Wheelchair Mission.
For those who would like to become actively involved, Free Wheelchair Mission is inviting the public to join Don and Dr. Mike on their cross-country cycling trek, which will take them from New York City to New Jersey, Pennsylvania, Ohio, Indiana, Illinois, Missouri, Kansas, Texas, New Mexico, Arizona, and conclude in Newport Beach, California on June 16.
For more information on the Ride for Mobility, to download a schedule to join Don and Dr. Mike, to make a donation, or to become a fund raiser for the Ride, log on to www.ride4mobility.org. For more information on Free Wheelchair Mission go to www.freewheelchairmission.org.
Editor's note: A full itinerary of the journey and cities is available upon request. Photos, B-roll are also available.
About Free Wheelchair Mission
There are more than 100 million disabled people in the developing world who have no access to wheelchairs due to poverty and economic isolation. Denied this most basic means of mobility, some crawl on the ground, subjecting themselves to dangerous, unsanitary conditions in order to maintain their independence. Others spend most of their lives in isolation, confined to a single room and dependent on family members to meet their most basic needs.
The Free Wheelchair Mission is a faith-based, non-profit organization based in Irvine, California. Its mission is to "Transform lives through the gift of mobility to the physically disabled poor in developing countries as motivated by Jesus Christ." Its vision is to "Creatively partner with like-minded international humanitarian and indigenous organizations to place 20 million wheelchairs."
The Free Wheelchair Mission provides wheelchairs at no cost to the disabled in the developing world. It has contracted with manufacturers in China to produce a basic but sturdy wheelchair using widely available parts. The wheelchair is designed to be shipped efficiently and assembled easily. The average cost to manufacture, ship, and distribute one of its chairs is under $50, an extraordinarily modest investment that changes the lives of the disabled and their families.
About Reader's Digest
Reader's Digest reaches 40 million readers in the U.S. each month. The magazine celebrates the best of humanity, and delivers a compelling mix of special reporting, humor, personal service, and human-interest stories. Reader's Digest is published in 21 languages and 50 editions worldwide. The company's main web site is at www.rd.com.
Media Contact:
Amy Toosley
Allison & Partners
Phone: 619/533-7976
E-mail: Email Contact
Jonathan Abramson
Free Wheelchair Mission
Phone: 949.273.8470 X 207
E-mail: Email Contact Posted Mar-16-07 07:10:41 PDT
Westbury resident Joe King, owner of Antun's Caterers in Queens Village, has signed on once again to be a major sponsor of the 2007 Nick Katsounis Memorial Wheelchair 10 Kilometer Championship Race.
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| Joe King of Westbury, owner of Antun's Caterers, and Antun's staff members Juan Arias (second from left) and Rudy Tufaro (second from right) are all smiles as they announce the support of Antun's to 2007 Nick Katsounis Memorial Wheelchair 10 Kilometer Championship Race Director and Deputy Director Geraldine Walsh and Joe Mendez, respectively. |
This year marks the 16th annual edition of the Wheelchair Championship Race, and it will be held on Sunday, June 24, with wheelchair athletes from all over the world converging on Long Island to celebrate the only road race in the United States that is for wheelchair athletes only.
Joe King and Antun's have provided important financial support to for the Wheelchair Race for the past five years, and the host Greater Long Island Running Club and race director Geraldine Walsh were very happy to welcome them back for 2007.
"We are thrilled to have Joe's support once again this year," said race director Geraldine Walsh. "We expect the biggest and best field of athletes from all over the world to be here for this year's race, and the support of giving, caring folks like Joe King and Antun's is especially important to us." Posted Mar-16-07 07:08:51 PDT
BROCKTON, Mass. -- Police in Brockton are searching for the person mugged a disabled woman while she was in her wheelchair.
NewsCenter 5's Jim Morelli reported that a 57-year-old woman, who did not want to be identified, was mugged as she returned from a convenience store on Wednesday.
"There was no need for him to hit me and punch me and stuff and try to pull me out of the chair when I told him I couldn't walk," she said. The woman is paralyzed from the waist down.
"I'm scared. Even when the phone rings, I get scared and jump," she said. "The first thing in my mind was, 'Please don't let him have a gun or a knife.' I couldn't fight back because of my arms and everything, and I can't walk."
She said that the person stole $750. It was money for her rent and Comcast.
"I know one thing. I will never go out by myself again," she said.
Police described the assailant as 6 feet tall, scruffy and skinny. The victim said that he was about 20 to 25 years old. At the time of the attack, he was wearing a black bandana, a Red Sox cap and a yellow T-shirt.
Anyone with information is urged to call Brockton police.
Copyright 2007 by TheBostonChannel.com. All rights reserved. This material Posted Mar-16-07 07:06:19 PDT Wheelchair lift giving one family a boost By JANELLE STECKLEIN
Herald-Banner Staff
A decision by the Hunt County Commissioners Court has made life easier for one Hunt County family.
Last November, the Hunt County Commissioners Court voted unanimously to spend up to $6,000 to purchase a wheelchair lift for the Lakes Regional MHMR day rehabilitation program. The lift has been recently installed.
Kim Mosley, who is wheelchair bound and mentally challenged, has benefited from the purchase, his father and Lakes Regional staff say.
Marvin Mosley, Kim Mosley’s father, said before the county chipped in the money to purchase the lift, he had to take his son to all the Lakes Regional events. But since the purchase and installation of the lift, his son has been able to go out into the community without him.
“It makes it possible for a person in a wheelchair to integrate into the community,” he said.
The van, which holds the lift, is able to accommodate two people in wheelchairs, though Kim is currently the only one currently utilizing it, said Sharon Ory, lead staff over the day rehabilitation program at Lakes Regional.
Ory said Kim Mosley was thrilled the first time he was able to go out without his father.
“He was just so excited,” she said. “He was just grinning and giggling. He did not want to go home.”
Kim Mosley also speaks highly of it.
“I think it’s nice,” he said.
Lisa Arnold, the organization’s service coordinator, said the lift was a needed addition for the day program. She said the most of the other Lakes Regional chapters already have lifts for their day programs.
“It improves the quality of life of our consumers,” she said.
The purchase gives Kim Mosley and his parents freedom. For the first time, Kim Mosley will be now be able to attend movies, picnics and spend time with friends without his father present. And his parents will have time to do things around the house while he is out.
Both Arnold and Marvin Mosley say they are thankful to the Commissioners Court for their generosity.
“I hope it benefits a lot of these young people,” Marvin Mosley said. Posted Mar-16-07 06:49:27 PDT
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The Electronic Retailing Association (ERA) has donated over $450,000 in marketing services to the Wheelchair Foundation in order to raise awareness for the global relief organization.
Arlington, VA (PRWeb) March 1, 2007 -- The Electronic Retailing Association (ERA), the only industry association representing direct response marketing companies and major retailers that use electronic media to sell goods and services to consumers, has donated over $450,000 in marketing services to the Wheelchair Foundation in order to raise awareness for the global relief organization. Providing a public service announcement, a radio campaign, a print campaign, telemarketing services, and media placement for free, the ERA Wheelchair Project hopes to garner international attention for the Wheelchair Foundation. Involving the entire direct response industry, the ERA Wheelchair Project inspired more than 30 companies to donate their time and services toward this charitable initiative.
"We have seen immediate differences since partnering with the ERA, " says Chris Lewis, Vice President of Public Education for the Wheelchair Foundation. "Our international awareness has increased dramatically and our increase in web traffic has been enormous. As a non-profit organization, traditional media was not a viable option for us. But with the help of the ERA, the entire industry is giving in a multi-pronged way, incredibly impacting people in need."
Dan Danielson, CEO and co-founder of Mercury Media and former ERA chairman, initiated the ERA Wheelchair Project in 2005. Originally inspired by the Wheelchair Foundation's relatively unknown presence, measurable outcomes, and international scope, Danielson desired to put the creative talents, time and skills of the industry to good use. ERA's international reach was also a perfect match for the tremendously global Wheelchair Foundation.
"The Electronic Retailing Association is an international association. We have members in Europe, Central and South America, Asia, as well as North America. It was important that we find an organization to fit our international profile," Danielson says.
Notable companies who have partnered with the ERA Wheelchair Project to donate their services toward this campaign include Apex Media, DIRECTV, Discovery Communications, ShopNBC, Livemercial, Novus Print Media, Icon Media Direct, Response Magazine and LiveOps. Internationally, companies in Canada, Latin America, Japan, and the United Kingdom have also donated their services.
In addition to providing services, ERA has raised over $187,500 for the Wheelchair Foundation, which is equivalent to over 2,500 wheelchairs. This year, the ERA Wheelchair Project is slated to distribute wheelchairs in Israel, El Salvador, Chile, Vietnam, and South Africa, and also plans to distribute over 280 wheelchairs in Hong Kong during its 2007 Asia Conference in April. While originally intended to be a one-year program, the ERA Wheelchair Project will now continue indefinitely due to its remarkable and unprecedented success.
Founded on June 13, 2000 by Kenneth E. Behring, the Wheelchair Foundation is the largest wheelchair relief organization in the world. Currently, the Wheelchair Foundation delivers up to 10,000 wheelchairs per month. Each wheelchair is high quality and specifically designed for developing countries. A similar wheelchair would sell for over $500 in the U.S. The Foundation estimates that over 100 million people in the world are in need of a wheelchair. Thanks to the efforts of the Wheelchair Foundation, wheelchairs are being donated throughout the world to those who desperately need assistance.
For more information on the ERA Wheelchair Project, visit ERA's website at www.retailing.org.
ABOUT THE ELECTRONIC RETAILING ASSOCIATION
Representing a more than $300 billion market, the Electronic Retailing Association (www.retailing.org) is the only trade association in the U.S. and internationally for major companies in the multi-channel electronic retail industry, which includes long- and short-form commercials, live shopping channels, the Internet and radio. ERA counts industry leaders like Guthy-Renker, HSN, QVC, ShopNBC, Match.com and eBay among its member companies. | | Posted Mar-15-07 11:35:04 PDT
The prolonged use of a wheelchair is a reality for over 100 million people across the globe due to disabilities brought about by illness, accident or advanced age. Among the challenges faced by this large and diverse group are; lack of access to adequate wheelchairs due to poverty, the risk of serious and even life threatening injury due to wheelchair roll-away or wheel pinning, and impediments to travel caused by the cumbersome nature of standard wheelchairs.
Fortunately, there are innovators at work who have in recent years addressed these issues through some truly amazing wheelchair inventions.
Don Schoendorfer, a mechanical engineer from Orange County, California, was aware that many of the poorest people around the world live on less than $2 a day, and that when they were needed, standard wheelchairs were financially out of reach at several hundred dollars per unit. Schoendorfer had a goal; to create the world's cheapest wheelchair for the benefit of poor people with disabilities.
Tinkering for three hours every morning in his garage workshop, Schoendorfer struggled to create a design for a wheelchair that would measure up to harsh terrains and climates at a fraction of the cost of standard wheelchairs. Finally inspiration came in the form of the ubiquitous white plastic lawn chair. The inventor used this low cost item as the centerpiece of his design, equipping his inexpensive chair with two sturdy bike tires and a custom designed chassis.
The result? A durable, low cost wheelchair that can be shipped anywhere in the world for under fifty dollars. Schoendorfer's nonprofit group, Free Wheelchair Mission, has delivered more than 75,000 to people in Angola, India, Peru, and Iraq. His mission? According to Schoendorfer, "I have a small goal. Twenty million chairs given away free by 2010."
In Minnesota, farmer turned inventor - Jerry Ford, was approached by his son Zack who worked in a nursing home and had noticed the dangers of elderly residents forgetting to set the brakes on their manual wheelchairs before attempting to stand. The result was often a bad fall as the wheelchair would roll-away from the resident as they applied weight to the chair’s arms when attempting to rise. A problem encountered by elders in other areas as well, especially among those who suffer from senility, Alzheimer's disease or just forgetfulness.
U.S. Congressman Gil Gutknecht of Minnesota has drawn attention to the problem, pointing out that a fall of this kind is “dangerous for the elderly, especially those in nursing homes, who are often fragile. Just one fall can be a painful death sentence."
Ford set to work almost immediately and in just a few hours, and with just $19 worth of spare parts, turned a mental picture of a new wheelchair automatic braking system into a reality. Ford’s invention is a revolutionary wheelchair safety system that allows the wheelchair to move when a patient is onboard, but which auto-sets a brake as soon as the user rises. The system does not compromise patient comfort or safety by causing pressure points and allows the wheelchair to operate normally including normal folding.
According to Ford, “our automatic wheelchair brakes and wheel locks help prevent falls, free up staff and improve quality of life… and that’s gotta make a guy feel good.”
On the other side of the world in Australia, Nick Morris is also innovating with an eye toward reducing wheelchair related injuries. His invention, the Vulcan Wheel, is an ergonomically designed one-piece extruded aluminum wheelchair wheel for use in general travel and sport. The unique Vulcan design has streamlined both the push rim and wheel rim of a conventional wheelchair wheel and provides the user with increased surface area to propel the wheelchair.
Morris was injured in a motorcycle accident at age 16 and credits his involvement in sport as the key to his rehabilitation. Nick's passion for sport led him to design an improvement on the conventional wheelchair wheel, in conjunction with co-inventor David Goding.
Conventional wheelchair wheels have a base construction made up of wheel rim, a push rim and a number of adjoining pieces connecting the rims together. In order to apply force to move a wheelchair, the user grips the push or wheel rim to propel the wheelchair forward. The wheel rim and push rim are joined together by five joins around the wheel causing a vast potential for hands to get caught or jammed in the gaps. This causes trauma and injury to the hands and fingers, often resulting in friction burns, dislocation of the fingers, and skin abrasions. It is also not uncommon for parts of clothing, or objects such as sticks and debris, to get caught in the gap. Secondly, there is insufficient room for placing the palms of the hand on the push rim, as there is not enough surface area between the wheel rim and push rim.
Morris and Goding’s ergonomic design compliments the use of palm and fingers and reduces the risk of trauma to the hand as there is no area for fingers, thumbs or external objects to get jammed in between the two rims.
The new wheel also weighs less due to a decreased number of components, and is less likely to break down. Its one-piece structure also provides the push rim with an additional degree of stability, making it less likely to buckle and flex when pressure is exerted during pushing, making it ideal for wheelchair sports.
Elsewhere the needs of those who travel with wheelchairs have been reviewed with an eye toward innovation. An Augusta Georgia firm www.wheelchairinabag.com offers a “wheelchair in a bag” that folds and unfolds in seconds and weighs in at just 17 lbs. The lightweight chair is made possible due to the use of aircraft aluminum, which provides the necessary strength with a fraction of the weight of steel. These compact chairs can be bagged and carried with a handle or shoulder strap and include features such as flip back armrests, folding footrests and adjustable wheel locks. Everything you would expect in a full weight chair. This Augusta Georgia firm has invented a concept that is ideal for the handicapped traveler.
Don Schoendorfer, Jerry Ford, Nick Morris and David Goding have made significant contributions through their inventions, which have improved access, efficiency and safety for wheelchair users throughout the United State and across the globe. And with the 21st Century still in its infancy there is every reason to believe there are more wheelchair innovations in store. |
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Jerry Ford is the Founder and CEO of a Minnesota based company specializing in automatic wheelchair brakes and wheel locks for manual wheelchairs.
http://www.jerryfordcompany.com/ | Posted Mar-15-07 07:57:11 PDT Updated Mar-15-07 07:58:23 PDT Acute care has its place
By Laura Youngs| Staff Writer
Walton Way's future could be a little brighter thanks to more than $20 million and the addition of a 71,900-square-foot hospital.
Wednesday's ribbon cutting at the new long-term acute care hospital, Select Specialty, was a year in the making and christens the first standalone facility of its kind in Augusta.
Mayor Deke Copenhaver said the hospital, near the 15th Street intersection, could be a sign of better things to come for Walton Way.
"Walton Way used to be a thriving corridor," he said after slicing through the ribbon with oversized gold scissors. "I see us going that way again."
He added that the investment could help lead a revitalization for nearby business, and surrounding neighborhoods.
Brian Davis, the chief executive of Augusta operations for Pennsylvania-based Select Medical Corp., the hospital's developer, said he is hopeful patients will be moved in March 27, once the final state inspections are completed.
The 80-room hospital - which employs 250, not including more than 200 physicians who will practice there - includes everything from intensive care rooms and bariatric care to facilities for procedures such as skin grafting or endoscopy.
Select Specialty provides round-the-clock, long-term acute care to patients stable enough to be moved from community hospitals such as University.
Those patients can include people who still need critical care, such as a burn victim or dialysis patients receiving wound-care.
Currently, Select Medical oversees 65 semiprivate rooms at University Hospital and Medical College of Georgia Hospital, where an average 55 to 60 people are patients at a given time.
Insurance rules often limit patient stays at places such as University Hospital, so those still needing critical care are moved to places such as Select for further treatment. Posted Mar-15-07 07:20:39 PDT
Posted Mar-14-07 09:32:03 PDT
SPARTANBURG, S.C. - Southern Home Medical Equipment signed a letter of intent last week to buy the Augusta, Ga.-based Wheelchairs Plus Mobility Solutions, a Web-based provider that generated $917,000 in revenues last year.
Wheelchairs Plus was an attractive addition to Southern Home Medical's portfolio due to its independence from Medicare, company officials said.
"They're virtually all private pay," said Dennis Nowak, Southern Home Medical's vice president. "We want to continue to diversify our services and business without having to totally rely on Medicare."
Southern Home Medical began rolling up HME providers late last year. Previously, it has announced plans to buy three companies in South Carolina: Mobile Healthcare in Greenville, Adaptive Medical in Spartanburg and ApneaRx in Clemson.
Wheelchairs Plus offers a wide-variety of mobility equipment, including a wheelchair-in-a-bag. In addition to its Web site, www.wheelchairsplus.net, it has a store on ebay(Wheelchair Store Scooter Store). Wheelchairs Plus is headed up by Michael Osbon, president; Jay Jernigan, CEO.
In addition to HME providers, Southern Home Medical has also continued to roll up health clubs. The company kicked off its efforts in January, when it bought the Ladies Health & Fitness franchise (See HME News March issue). Last month, it bought a second club, Fast Track Fitness, which it plans to rename Ladies Health & Fitness.
Southern Home Medical plans to franchise 50 clubs in the Mobile/Pensacola, Fla., market and 40 clubs in the Charleston, S.C., market, respectively.
News Link http://www.hmenews.com/index.php?p=article&id=hm200703aknSa0 Posted Mar-14-07 11:06:03 PDT
Medicare Buts on Wheelchairs
Some good to know facts when chasing Medicare down for a wheelchair. We were not quite sure if the correct spelling was "Buts" or "Butts", so we erred in favor of less typing.
*The term wheelchair is a generic term used to describe manual wheelchairs, powered wheelchairs, and Scooters |
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Medicare pays for a wheelchair when needed for "In the home" use only. This means that they will not consider anything that you need to do, want to do, or would be able do outside of your home if you had the correct wheelchair.
But- Many organizations such as Right Wheelchair, ITEM Coalition, and Clinician Task Force, are working to change this. Why aren't you helping them?
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| •Activities of Daily Living Requirement |
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In a recent decision in May 2005, Medicare decided that mobility, unto itself, is not a medical necessity. For Medicare to purchase a wheelchair it would have to help you accomplish an ADL (activity of daily living).
But- If you can stumble into your kitchen to make a sandwich, fall into your bathroom to comb your hair, or crawl into your closet and grab some clothes to wear. Well then, your going to be out of luck.
Butt- If you have no problem with performing these activities but just need to get to the right place to do them, hmmm, that doesn't look real good in Medicare's eyes either. You may be out of luck there also. The logic- The wheelchair needs to enhance your ability to "perform" these activities. In this case it doesn't. You are already able to perform them. You just can't get there to do it.
Buttt- Regardless of all of the above, Medicare will still not consider any of your wheelchair and mobility needs outside of the home.
Medicare held open forums and requested input prior to making this decision. A large number of wheelchair users and organizations along with some of the nation's brightest clinicians and some of the wheelchair industries sharpest people commented on this issue. These concerned parties were universally against Medicare on this issue. They did it anyway. Medicare has sent a clear message that they are not concerned with the welfare of their clients or the opinion of organizations and professionals.
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| •Certificate of Medical Necessity (CMN) |
This is an order that your physician "must" complete in order for Medicare to pay for your wheelchair. It contains information on your disability, the type of wheelchair you need, and the medical justification for the wheelchair. Your wheelchair dealer must have a signed copy of the certificate from your doctor in order to further process your wheelchair claim.
But- If anything is left out or if any of the information or dates are incorrect, guess what? Medicare will deny the claim and you are back to square one. In certain cases, including those where an honest mistake or oversight was made on the certificate, your physician or wheelchair dealer may be accused of submitting a fraudulent claim.
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| •Your Medical Record |
Your medical record must contain sufficient documentation of your medical condition that substantiates the need for the wheelchair. The record should include diagnosis, duration of the condition for which the wheelchair is needed, prognosis, nature and extent of your functional limitations, other therapeutic interventions that have been tried and results, and information on any other similar device that you have tried. A copy of the Certificate of Medical Necessity (CMN) should also be included in your medical records.
But- The information on your medical record is not enough to get the wheelchair claim approved and paid for. It is a component of the entire documentation process. Medicare can always ask for more detailed documentation, disagree with any part or all of the documentation, and even declare it fraudulent.
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| •The Wheelchair Dealer |
The wheelchair dealer or supplier not only supplies the wheelchair but they are also the ones who gather up all the information, double check it for accuracy, make sure that it meets Medicare's guidelines and then pack it all off to the eagerly waiting Medicare folks.
But- If there are mistakes or incorrect information the claim will be denied by Medicare and the supplier may have to absorb the dollar cost of part or all of the wheelchair. Medicare may also declare the claim to be fraudulent and even impose fines on the supplier.
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| •Advance Determination of Medicare Coverage (ADMC) |
You or your wheelchair supplier can request that Medicare make a determination prior to delivery of the wheelchair to find out whether Medicare will pay for the wheelchair. Medicare has 30 days to respond to this request. Not a bad thing for you or your supplier to know...
But- This determination is not the official last word. Things can change depending upon what they see when they receive the entire documentation package. If Medicare returns the ADMC, and changes need to be made to better explain or justify your need for a wheelchair, then keep a calendar close by since you can only submit this request once every six months. Even if you get an affirmative answer from Medicare, the thumbs up does not extend to the price of the wheelchair. Hey, I'm not making this stuff up, they are.
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| Durable Medical Equipment Regional Carrier (DMERC) |
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The DMERC's are the ones who will ultimately decide if you get the wheelchair that your physician, therapist and equipment dealer have recommended for you. They will also be the last word on how much Medicare will pay for the wheelchair. Medicare has divided the nation into four regions, each region has a DMERC that is responsible for handling claims in certain states assigned to them.
But- The DMERC's are not government or Medicare departments. They are private sector companies that have been contracted by Medicare to manage these programs. Medicare issues guidelines and policies that they follow. The DMERC regions are identified by the letters A, B, C, and D. Presently the DMERC contractors are:
| DMERC's |
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| Region A- Healthnow New York, Inc. |
www.umd.nycpic.com |
| Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. |
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| Region B- Adminastar Federal, Inc. |
www.adminastar.com |
| IL, IN, MD, MI, MN, OH, VA, WI, WV and Washington DC |
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| Region C- Palmetto GBA |
www.pgba.com |
| Alabama, Arkansas, Colorado, Florida, Georgia, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas and the Virgin Islands. |
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| Region D- CIGNA |
www.cignamedicare.com |
| Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Mariana Island, Missouri, Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming. |
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| •Medically Necessary or Unnecessary? |
| Medically necessary or unnecessary are the responses most often used by Medicare to describe items they approve for funding and those that they do not. It is based on whether or not they determine, by their rules and interpretations, if the wheelchair is or is not medically needed, and if it meets the needs of the intended user. |
| But- There is a dramatic difference between a wheelchair being medically necessary by Medicare's standards and by the medical and clinical communities standards. If you are able to push your manual wheelchair well enough within your home to accomplish (to some extent) your daily in-home tasks and activities then Medicare would decide that a power wheelchair was "Medically unnecessary". The fact that a powered wheelchair would make you more functional and independent in general doesn't count. The fact that you are unable to push your wheelchair to the doctors office 1/2 mile away, or to the pharmacy around the corner, or to the grocery store up the block, or even to your shrink's office in the next apartment doesn't matter much to Medicare either. Medicare's regulatory interpretations dictate that they consider only those activities and functions that take place "in the home". Right back to square one again. | Posted Mar-14-07 10:30:23 PDT Finland
Baby boomers like to spend, retail thrives
Mis en ligne le 14/03/2007
In 2006, commerce in Finland increased by 4.5%, and home technology led the sales. Some analysts point out that the increasing number of pensioners will affect consumption.
Managing Director Guy Wires of the Federation of Finnish Commerce considers the outlook for Finnish retail trade excellent. He sees growing interest rates and overheated housing markets as the only short-term risk factors that can rob money from purchasing to interest payments. In the long term the biggest risk is the availability of workforce.
In 2006, commerce in Finland increased by 4.5% and the federation expects 3.5% growth for 2007. Wires states that 2006 was a record year in terms of sales volume and value. It was a problem though that Finns spent too much on credit.
In 2006, food and supermarket sales normalised and the entire retail sector grew. Home technology led the sales. Regulators and weather factors affected some segments negatively. Finnish speciality retail stores are grappled by change. International chains keep entering the market while the number of retail stores goes down. Wires expects the structural change to go on for a long time.
Wires points out that the increasing number of pensioners will affect consumption. Baby-boomers are different consumers than previous grey generations. They are willing to invest in high-end products in all walks of life. The trend is well visible in food retail. Ageing will also influence the demand for small corner shops in the future.
(Esmerk Finnish News, "Finland: Baby-boomers like to spend, retail thrives", 03/01/07) Posted Mar-14-07 10:21:05 PDT
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News for Baby Boomers
Experts Predict Top Trends in Marketing to Baby Boomers in 2007
Market gets attention due to its size - $2.1 trillion in spending power
 March 6, 2007 – Some of the top speakers at a conference on marketing to baby boomers pooled their knowledge yesterday to select the top trends in the boomer business for 2007. Number one is the need for business to change their management models to keep boomers in the workforce. The others involved political power, health, women's self image and changes boomers will make to retirement.
On the first day of the “Fourth Annual What’s Next Boomer Business Summit” in Chicago, Fleishman-Hillard’s FH Boom polled some of the conference’s top speakers on their predictions. Their answers provide unique insights into how companies and organizations can tap into this 78 million strong powerhouse generation, according to the company.
Trends were provided by Gail Sheehy, author of Passages and Sex and the Seasoned Woman: Pursuing the Passionate Life; Steve French, Managing Partner of The Natural Marketing Institute (NMI); Myrna Blyth, founder of MORE magazine and author of the New York Times best seller Spin Sisters and the soon-to-be-published How to Raise an American; Carol Orsborn, Ph.D., co-chair of FH Boom and co-author of BOOM: Marketing to the Ultimate Power Consumer – the Baby Boomer Woman by Mary Brown and Carol Orsborn; and Sandra Timmermann, Ed.D., Director of the MetLife Mature Market Institute.
“Because of its sheer size and $2.1 trillion in spending power, more and more companies are waking up to this generation and adapting their business with an eye towards the boomer demographic,” said Eileen Marcus, Fleishman-Hillard Senior Partner and FH Boom co-chair.
“With competition for boomers’ attention increasing, how can the smartest organizations stay one step ahead of the rest, reaching boomers quickly and effectively to motivate their support and maintain their contributions? That’s what we sought to identify at the Summit.”
The summit is co-produced by the American Society of Aging Business Forum on Aging and Mary Furlong & Associates and is a preconference of the 2007 Joint Conference of the American Society on Aging and the National Council on Aging. FH Boom (www.theboomerblog.com), the first U.S.-based practice by a global PR firm exclusively dedicated to helping companies connect with boomers, is a Bronze Sponsor of the Summit.
“There is no market opportunity larger than the boomers,” said Mary Furlong, co producer of the What's Next Boomer Business Summit and author of Turning Silver Into Gold: How to Profit in the New Boomer Marketplace. “This event showcases the leading entrepreneurs, corporations and market researchers serving this market. Attendees are getting an amazing download of the data and connecting with how to market to the customer with the latest media and interactive tools.”
The top five trends for boomer business in 2007 include:
1. Work & Management: Gail Sheehy warns that companies will need to shift their management models to retain their boomer employees, or risk a dangerous loss of institutional knowledge and sudden reduction in their work force. She also encourages boomers to use this situation to create the work experience they desire.
“There is a hidden brain drain in the American work force,” she says. “Corporate America is beginning to wake up to a seismic demographic change. If it lets boomers retire early or drop off the radar, corporations won’t have the people power to remain competitive in a global marketplace. The rate of growth in the U.S. work force will fall drastically over the next 20 years. This change offers a golden opportunity for skilled boomers to reverse age bias and transform the corporate model to suit their needs to continue working for meaning & money.”
2. Products & Services: Based on NMI’s Healthy Aging/Boomer Database, an annual quantitative study of the U.S. Boomer population, Steve French predicts that the convergence of health and wellness, both in terms of personal health and planetary health, will lead to a plethora of new products and services targeted to boomers, including consumer packaged goods, the travel industry, media patterns, the automobile industry, and healthcare, among others.
“The impact of Baby Boomers on cultural trends, product/service innovation, and economic movements has been well documented for many years,” said French. “Based on Boomers’ desire to age gracefully, live a healthy life, and maintain quality of living, the notion of healthy aging is being transformed across many industries. Based on the multifaceted challenges faced by Boomers, the unification of health, wellness, and sustainability creates a plethora of solutions for this influential portion of the population to embrace. Look for innovative, new products and services that provide such integration.”
3. Beauty & Self Image: Myrna Blyth sees boomer women embracing their beauty as they age, rather than fighting it. “The goal of boomer women will not be to look younger but to feel better and more accepting about the way they look,” she said.
“That doesn't mean these women want to look dowdy or out-of-it. Just the opposite. They want to look as good as they can and they want to celebrate the vitality and the self-confidence their experience has given them. Think Helen Mirren! Also the Dove beauty campaign has been very successful because it celebrates women of every age, shape and ethnicity who look good because they feel good about themselves. Boomer women who think they look better even as they get older – and frequently do – are leading the way.”
4. Political Power: Building on her observations regarding the impact of boomer women in politics, Carol Orsborn predicts the rise of boomers as a political constituency leading up to the presidential elections in ’08.
“At 78 million strong, boomers are the single largest generational cohort of voting age—and they are just now beginning to flex their social and political muscle,” said Orsborn. “Boomers have traditionally had a sense of entitlement in the face of their needs and desires. And heaven knows, these qualities are only going to increase with age and in the face of increasingly challenging life situations. Look towards social and economic issues that impact them or even more immediately, their aging parents, as an indication of which institutions and policies will feel the heat first.”
5. Retirement: Sandra Timmermann predicts that, with longer lifespans and changing definitions of their circles of trust, boomers will revolutionize retirement.
“Boomers may spend twenty, thirty or more years in retirement – however we define it – and it may turn out to be their longest lifestage,” said Timmermann. “They will look for two types of advisors – a life coach to help them think through how they want to spend the rest of their lives and a financial coach who can help them figure out how much money they will need to last throughout their lives. Retirement planning will take on a ‘longevity focus.’ It won't be just about the bag of cash they need to accumulate, but will instead be about guaranteeing a steady stream of lifetime income. Many boomers will work in retirement to bring more money in. And to maximize their retirement, Boomers will explore new kinds of living arrangements – think about the Golden Girls – so they can age in place with ‘families of choice’ to share expenses and to care for one another should they need assistance some day.”
From these trends, it is clear that boomers’ influence on society will be profound, according to Marcus.
“These predictions represent radical changes to some of the building blocks of American life,” said Marcus. “Work, family, politics – none are areas to be taken lightly. This is why events like the What’s Next Boomer Business Summit are so important – by bringing together the best minds on boomers, we can collectively prepare American businesses and citizens for the changes to come.”
“Aging is the most cross cutting challenge and opportunity facing American society,” said Helen Dennis, Chair of ASA’s Business Forum on Aging. “Business has a profound role to play in developing innovative products and services that will support the longevity revolution. Clearly the boomers are driving the agenda that ultimately will serve every maturing generation.”
Editor's Notes:
About FH Boom & Fleishman-Hillard
FH Boom is Fleishman-Hillard's marketing-to-boomers practice, the first American-based practice group by a global PR firm dedicated to helping companies build powerful relationships with baby boomers in the U.S. and across the FH international network. The practice offers research, training, program assessments, creative strategy and insider intelligence on how to effectively reach, connect with and motivate the men and women of the boomer generation. For more information, visit www.theboomerblog.com.
Fleishman-Hillard Inc., one of the world's leading public relations firms has built its reputation by using strategic communications to deliver what its clients value most: meaningful, positive, and measurable impact on the performance of their organizations. The firm is widely recognized for excellent client service and a strong company culture founded on teamwork, integrity, and personal commitment. Based in St. Louis, the firm operates throughout North America, Europe, Asia, Latin America, Australia, and South Africa through its 80 owned offices. For more information, visit the Fleishman-Hillard Web site at www.fleishman.com. | Posted Mar-14-07 10:12:14 PDT Power Wheelchair Sales Down 50 Percent; Seller Claims Medicare to Blame For Fewer Seniors Getting Power Mobility
Scooter Store to release 200 employees, cut expenses
New Braunfels, Texas, Sept. 1, 2004 - The SCOOTER Store, the nation's leading provider of power wheelchairs and scooters, has announced the release of 200 employees who are no longer needed as a "direct result of a Medicare policy change" that has drastically cut the number of senior citizens who can receive such assistance.
"While we deeply regret having to part with any of our employee family, the continuing impact of restrictive Medicare policies leaves us no choice," said Doug Harrison, chief executive officer of The SCOOTER Store. He pointed to industry reports that the number of seniors who receive power mobility assistance this year will be down by approximately 50 percent from 2003, despite a growing population of Americans who are living longer then ever.
"As painful as this move is to all of us, the greater tragedy is the denial of assistance to qualified mobility-impaired individuals," he said. "Our elderly with severe health problems, those who are most in need of assistance from the Medicare system, are being hit hardest through no fault of their own."
Early this year The SCOOTER Store was forced to lay off approximately 200 workers and has reduced numerous other expenditures. Last week the company announced a restructuring that included the appointment of Mike Pfister as president.
Pfister said the organizational changes are aimed at preserving the company's stability through a time of industry change and challenge.
"We simply must resize the company to the current market environment to assure that we remain viable to carry on our mission to provide freedom and independence to our nation's mobility impaired," he said. "The SCOOTER Store remains committed to serving the needs of current and future customers nationwide in any regulatory environment."
Pfister explained that the drastic cutbacks in Medicare reimbursements came after the Centers for Medicare and Medicaid Services (CMS) reversed previous policies and issued on a retroactive basis new "clarification" guidelines that he said have denied many disabled elderly the assistance granted in the past. He said the action was intended to help combat fraud and abuse of the system, but instead has harmed seniors and scores of legitimate providers who have gone out of business or stopped providing power mobility equipment altogether.
Medicare has provided coverage for such devices since 1996 to people requiring this equipment to accomplish activities of daily living inside their home.
"The 'clarification,' as interpreted by CMS contractors, now frequently denies the power mobility benefit for any person who can take more than a single step inside his or her home at any time," Pfister said. Although CMS rescinded the "clarification," its contractors continue to audit claims based on those guidelines, he noted.
"The SCOOTER Store actively is appealing denied claims worth millions of dollars in Medicare reimbursements for power wheelchairs already delivered that were prescribed by patients' personal physicians," Pfister said. He noted that historically 70 percent of these appeals are successful, and Medicare is ordered to pay the claims.
In a related recent lawsuit, a U.S. District Court ruled against CMS, re- establishing that Congress, not CMS, sets the criteria for documentation of medical necessity. At issue was the importance of the Certificate of Medical Necessity (CMN), a document mandated by Congress for physicians to complete that affirms the medical need for power mobility equipment. The court ruled that Congress intended the CMN to be the sole document necessary for Medicare to determine medical necessity, and that the agency should not second-guess the decisions made by treating physicians.
Federal officials currently are re-examining appropriate coverage standards, but further clarification is not expected until early next year.
"Providing support to those who need assistance in order to remain living independently in their homes not only is the right thing to do for America's elderly, but also is sound business for the federal government and the taxpayer," Harrison said. The alternative, full-time nursing care, costs CMS thousands of dollars per month for each covered beneficiary. Medicare data shows that among beneficiaries with similar disabilities, those who received power mobility equipment generated less cost to the system overall than those who did not receive such assistance, even after paying the cost of the power wheelchair.
"We are confident that our country will not turn its back on our seniors," Harrison said.
The SCOOTER Store now has approximately 1,000 employee/owners, and will continue operating its current retail locations and distribution centers across the country. All affected employees will be provided severance benefits, career counseling and job placement assistance. Posted Mar-14-07 10:08:22 PDT Home > Business > Business News
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Michael Osbon, the president of Wheelchairs Plus, demonstrates how to use the Everthere carrier to hold a scooter. Wheelchairs Plus and Everthere have joined forces, both selling their products on the Internet.
Andrew Davis Tucker/Staff |
Local business picks up by latching onto Internet Web posted Saturday, March 14, 2007
It once took a staff of five to do what George Pocisk can do by himself today.
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| Wheelchairs Plus.net is selling the Everthere carriers on its Web site to be used with personal scooters such as the Invacare Zoom 220 shown above. The two companies have benefited tremendously from | | |
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