What I learned in Vegas and bringing it back to Yakima!

Spring MedTrade 2015  

It’s that time of year again. Our semi-annual trade show in Vegas where all the business leaders who run medical supplies gather in Las Vegas to network and look at the newest products. I want to share some of my insights from the trip.

Several hundred of us cramped into a large room to hear what is next in Washington DC and legislation.
Several hundred of us cramped into a large room to hear what is next in Washington DC and legislation.

I always like seeing new products. Three of my favorites:

  1. Evolution walkers:  We have carried these for over a year now. These are the BEST walkers on the market and they are priced this way too. For the person who doesn’t want to deal with the generic Medicare walker and has the money to spend, this is the way to go. We call them European walkers because those in Europe know how to get around and appreciate walking. We have three different kinds of these walkers at our store so try both the Medicare walker and this one out and you’ll see what we are talking about!
  2. Sunrise Medical who handles all of our lightweight wheelchair products has a new no-insurance wheelchair. Howard’s is the exclusive dealer here in Yakima. Some of the neat things you get in this chair: easily adjustable push handles (which is great for someone like me who is 6’2” tall), brakes on the handles instead of having to bend down and set them on the wheels, and disc brakes. All of the other qualities of a lightweight wheelchairs are still there including quick release axils but they took a good wheelchair and made it great!
  3. How does someone who is a quad supposed to easily pull their pants up in the bathroom? There is a product now for this individual called pants-up-easy. This is a product we can order for these individual because they deserve to be independent just like the rest of us!

I hate talking about this, but most of our business is contingent on what is going on in Washington DC. In January of 2016, Medicare is planning on making rural areas accept the larger city’s reimbursements. What this really means for the residents of the Yakima Valley is we will be reimbursed less for our medical products. For example instead of being reimbursed $182/month for oxygen, this will drop to close to $100. Instead of $140 for a walker with seat, this will drop to $85. It doesn’t take a rocket-scientist to know you won’t get the same quality product.

Howard’s recently joined AA Homecare to help in the lobbying effort to make this so it doesn’t happen. If it does go though we will be okay as business; however, Howard’s will have to become even more efficient and handle more with less. What this means for our customers is we frequently have to provide a more affordable options instead of what we currently offer. Yesterday as an example, we had a patient who needed help and adjustments on a product in Mabton, we made the trip. These trips will be harder to make if Medicare forces us to do more with less and those patients will have to come to our store instead of us going to them.

It was Vegas and I did bring my daughter.  In-between networking, I did get 30 minutes of swimming in the wave pool.
It was Vegas and I did bring my daughter. In-between networking, I did get 30 minutes of swimming in the wave pool.

Last and my favorite part of MedTrade was the networking. There are not many of us here in Yakima who run a medical supply store. I had a great opportunity to go to dinner with another family owned DME out of Wenatchee and another out of Oregon. We shared some of our secrets about taking care of our customers, winning audits, and what we can do to become even better at our trade (what we call our Ninja secrets here at Howard’s).

Erik at Howard’s


Building Block Nebulizers!

Lego Neb by AirialDo you hate trying to get your kids to eat their vegetables? I can only imagine in my family how much easier and more enjoyable dinner time would be if we did not have to go through this ordeal every night. Imagine if you have a young one who has asthma and has daily treatments with a nebulizer? I have good news and its . . . AWESOME!

Howard’s just received our first shipments of block nebulizers that kids can play with. We had a child in our store yesterday and he was excited for his asthma treatment because now he gets to play while taking his medication.

In addition to the starter set, we have two other nebulizer packs (one with pirates) and the pricing starts at $14.99 so if you are a mom or dad and have a little one who needs their nebulizer, go with the FUN way and try our new nebulizers. Also, if you are older, we won’t judge, you can get one too if you’d like!Pirate Series Neb

Last, nebulizers are covered under all insurance programs if you have a valid prescription and diagnosis.

Call us if you have any questions, we are here to help!

Erik at Howard’s


City Series Lego

Preparing for surgery

Preparing for surgery can be full of anxiety. About of the quarter of the patients we work with at Howard’s are surgery patients. Hip replacement, knee replacement, back surgery, etc.  Most of these surgeries are predicable where the patient has had some kind of chronic problem and then after all other forms of therapy, drugs, and alternate forms have failed the patient decides to jump in and get cut.

We have some amazing doctors in Yakima or Seattle depending on where your surgery takes place so know you are in good hands. When the surgery is done though, there will be a period of recovery that varies in time depending on your surgery.

I went through back surgery last year and it was hard for me to realize I would be sidelined for a period of time given I had backpacked 18 miles over hilly terrain a few months earlier. I thought I would rebound quickly. However, when you are cut in surgery, there is a set amount of time the body must recover and no matter how fit or unfit you are going into surgery it is going to take a few weeks to months to recover.

After you get out of surgery you will have a team of nurses that tend to your every need. But once you go home, unfortunately the nurses do not go home with you. So what are you to do?

This is where Howard’s comes into play.  We have multiple items designed to make you or your loved one’s life easier as they recover from their surgery:

  1. The lift chair—For a patient that has either hip or heart surgery these are a must in our opinion until strength comes back. At Howard’s we rent them for $75/week or $150/month. Delivery, setup, and removal are included in the price.  Even if you are strong, the lift chair will recline and lift you up at the push of a button.  They are even very comfortable and allow for sleep if you would like.
  2. Hip kit (this is pictured on this page)—If you have had back, hip, or heart surgery you may lack the strength for several weeks you had pre-surgery. The hip kit (pictured) comes with a reacher, extra-long shoehorn, elastic shoelaces, long sponge for the shower or tub, and stocking donner to help you put your socks or compression hose on. The complete kit runs $49.99 or you may by each individual item separately at Howard’s too.
  3. Bedside table—You may be spending a lot of time if your favorite chair or couch, you will want to eat and read frequently from this location. The bedside table is very helpful as it is on wheels and has a height adjustable feature to it.  We rent them for $15/week or $30/month.
  4. CPM—A Continuous Passive Motion machine is needed for anyone who has knee surgery to keep the joint moving. Usually insurances will cover these items for 21-days post-surgery.  Howard’s has a complete inventory of CPM machines so make sure you have a prescription
    The hip kit from Howard's comes with everything you will need to recover from hip surgery.
    The hip kit from Howard’s comes with everything you will need to recover from hip surgery.

    and pick it up at least two days before your surgery.


  • For our rental fleet of lift chairs, we only use Crypton fabric from Pride Mobility. This fabric is waterproof and allows for disinfecting after each patient.  Because it is a fabric, it is still comfortable and not uncomfortable like the old vinyl lift chair of the past.

As always, if you have any questions or need home healthcare supplies give us a call at 509-654-9899 and let our family serve your family’s healthcare needs.


Benefits of a HSA

We waste a lot of time at Howard’s! Not really if you look at it from a business perspective; however, the average oxygen patient for us to get their paperwork covered by Medicare requires eight faxes and two trips to the doctor’s office. A complex rehab wheelchair runs around ten faxes, three trips to different provider’s offices, and a final patient file that usually is over forty pages long. Even something as simple as a basic brace comes with a prescription and at least five pages of documentation and intake forms.

Why not use a HSA account instead?

The HSA or health savings account in my opinion could solve our country’s health insurance problem. For those that do not know what a HSA account is, it is a tax advantaged savings account for people who are enrolled in high-deductible insurance plans.

From a personal family standpoint, I decide how to spend our family’s money.  Instead of being limited on what our insurance covers, we can use it on what our family feels serves our health needs best. There are requirements to things you can and cannot spend the money on.  For example, a health club membership would not count.  But items our family has used the money on: chiropractic care, massages, drug prescriptions, copays at our doctor’s offices for check-ups and test, etc. are covered under a HAS plan and tax-free (in 2015 $3350 for individuals and $6650 for families).

Now if it were up to me, I would give a cash discount to anyone who wanted to buy at Howard’s because this would make a lot of sense because it would allow us to focus on taking care of the customer instead of chasing chart notes and paperwork. Unfortunately, Medicare does not want us to do this because there is actually a law that states we need to give the same price to Medicare as everyone else.  So what have we done at Howard’s? We have two lines of braces and products: one for our insurance patients made by a specific brand; we also have another brand (non-coded for you high-compliance lawyers out there) that we have specifically for our HSA patients or cash pay patients.

For example, our carpel tunnel wrist brace through Medicare and insurances we charge about $79.99*. A very similar brace from our similar vendor for our HAS or cash pay customers runs between $19.99 to $29.99. See the difference in price?  Likewise our insurance scooter (coded at K0008 for our lawyers) runs $1499.99.  A very similar scooter (coded E1399 which is a misc. non-covered code by Pride Mobility our scooter provider) sells at $999.00.

Now there are usually two people out there who come into the store who figure out what we are trying to do at Howard’s. The first group applauds what we are trying to do. The second group will frequently get mad at us for circumventing the rules of Medicare.  However for this second group who wants us to give Medicare the same pricing, I want to remind this is the same Medicare who requires us to use costly methods of paperwork, faxing, visiting doctor’s offices, etc. to meet their documentation requirements.

In summary, know that if you are paying for an item with cash or a HSA account you can get a nice discount if you buy specific items.  If you are a patient who has Medicare or Medicaid (DSHS in the state of Washington) please be patient with us because your insurance has us jump through a lot of hoops before we are paid.

Erik Mickelson—Team Lead and ATP at Howard’s Medical

*Now on these prices that we charge, most insurances including Medicare have something called an “allowable” which is what we are actually paid on the item.  At Howard’s we comply with these allowables.  For carpel tunnel wrist braces they run between $45-70 and if you have a copay, your copay would be off of the allowable amount and not the charged amount.  We work and bill with over 100 insurances so this means over 100 different allowables. I leave this up to our incredible billing team!

Getting your wheelchair covered by Medicare

Working in DME (durable medical equipment) and getting items covered by insurances is a lot like purposely asking for 1,000 paper cuts. There is no degree that prepares one for medical supplies (I have a bachelors from the University of Washington in English with a minor in History).

We struggled for years fighting with doctors, patients and especially Medicare getting the necessary paperwork to get one’s wheelchair covered by insurance.  Even when you think you have everything, process the claim and get it paid, Medicare will come back with post-payment audits and can take their money back! What I learned in getting my college degree though is nothing is more valuable than doing your own first-person research on an individual area of study.

The Breezy Ultra 4 is our standard high-strength lightweight wheelchair we are currently using at Howards.
The Breezy Ultra 4 is our standard high-strength lightweight wheelchair we are currently using at Howards.

We have been in business now going on our second decade at Howard’s and we are very optimistic given the difficult environment CMS (i.e. Medicare) has us follow.  Some of the things Howard’s does to get our wheelchairs covered is we have a staff of four full-time team members devoted just to wheelchairs.  We have a team member (Alyssa) who is in our retail store daily to take all phone calls. We have two ATP’s (Daryl and myself) who do all fittings and build wheelchairs. Last, we have Aleah (my wife) who masters the LCD (local coverage determination or in Medicare’s words: their pages and pages of requirements for an individual item to be covered).

Unfortunately this is not the most efficient way of getting equipment into our patient’s hands.  A lot of time I dream of saving our government money but in life we have to play by the rules that our government gives us.

If you or one of your family members needs a wheelchair, give Howard’s a call 654-9899 and ask for a member in our wheelchair/rehab department.  We pride ourselves on staying up-to-date on the latest technology as well as the requirements for the equipment you need and deserve.

Erik Mickelson—ATP Howard’s Medical

What happens when you are sick or hurt?

Last year I came down with a terrible back injury and it has taken me almost 12 months to recover from it. I managed to herniate my L5/S1 disc.

No one plans on getting hurt or sick but

Here is the MRI of my herniated disc before it was repaired.
Here is the MRI of my herniated disc before it was repaired.

when it happens it is vital to have your team in place to help you recover.  In Yakima we have incredible doctors and therapists in this city to get you back on your feet. If something unexpected comes up and you need medical equipment  needs, whether  crutches, braces, nebulizer, or other items, the team at Howard’s Medical is here to help you offering two locations and delivery services for the entire valley.

The good news is after herniating my disc, I am finally healed!  Last year I did try: two rounds of physical therapy, chiropractic care, massage therapy, inversion tables, back and SI braces, etc. No two of us are the same when it comes to injuries which is why it is imperative you have a good team in place.  Howard’s is the medical supply/pharmacy to come alongside your other important team members if you ever find yourself injured or sick.

Here is hoping that your 2015 is filled with health and wellness,

Erik—Howard’s team lead

Yakima’s air

If you have to have a nebulizer treatment, might as well have a cool looking fish or dog!
If you have to have a nebulizer treatment, might as well have a cool looking fish or dog!

Winter and springtime can be a really difficult time for people with respiratory problems in the Yakima Valley as the air goes from stagnation to being filled with pollen.  At Howard’s Medical, we come alongside doctors by offering home oximetry testing which tests one’s oxygen saturation level as well as heart rate which is a great respiratory screening tool.

It is mid-February and my family has each already had the flu.  Our doctor in Selah told us that the flu is pretty much epidemic in the valley right now unfortunately.

So what does this mean? If you unfortunately need a home nebulizer, you can pick these up at either or Selah or Yakima store.  If you can’t come, give us a call at 654-9899 and we offer deliveries anywhere in the Yakima Valley.

If your doctor does order an oximetry test, we have to have a valid prescription on file for this.  These tests are a wonderful diagnostic tool and really helps him/her figure out how much of a respiratory problem one person may have.

Last, we also offer home and portable nebulizer units which dispense prescription medication.  For super active patients, a portable nebulizer if great because a child with asthma can get a treatment before soccer practice in the car as an example. For other young kids, we have kid-centric nebulizer units like a doggie-neb.

Looking for an operations team member

We have a job opening at Howard’s!


● Serve the customers of Howard’s Medical Supply by offering superior customer service and top quality medical supplies.

• Must be flexible, dependable, and have the ability to solve problems while on the go
• Communicate effectively with seniors, people of all ages and coworkers, smile and make people feel welcome; be willing to “go the extra mile”
• Must be competent with use of computers, email, and internet.
Responsibilities Include:
• Cleans and repair dirty equipment that comes back from rentals (estimate 20 hrs/week)
• Processes telephone orders by preparing patient paperwork
• Coordinates the delivery, set-up and pick-up of equipment, supplies and services with appropriate personnel
• Schedule appointments
• Helps load delivery vehicles in the warehouse picking orders
• Keeping an orderly warehouse
• Work as delivery technician delivering oxygen, hospital beds, wheelchairs and other medical equipment directly to patient’s home explaining how to use equipment (estimate 15 hrs/week) and be on-call on average one out of every 4-6 weeks (depending on the number of technicians we have on staff)
Education and/or experience:
• No experience necessary but recommended. Must be at least 18 years of age or older and be able to lift 50 pounds with valid driver’s license.

• 401k, Profit Sharing, Fitness Membership

● Flexible (30-40 hours/week) depending on customer traffic Monday-Friday. Work one Saturday whenever on-call each month.

*** If you are interested in this position please put Attn: Mr. Ferguson in the subject line. This way we know you are not a robot. If you do not have a resume or don’t know how to use email, Howard’s is not the right place for you to work because we love using technology at Howard’s! Last, when you send your email to us with your resume, we will email you back a few questions. You will have 48 hours to respond to these questions and from this, it will decide whether or not we call you or not for an interview.***

If this is something you are interested in, email your resume to “chad” “at” “howardsmedical” dot com.

We will be taking applications through February 28th.  If you see this post after that, feel free to email us your resume anyway as we always keep these on file if another job ever opens up.

2015 Insurance Deductibles

One of the first things everyone should do in the new year is spend five minutes calling their insurance asking what the requirements are for any of your prescription medications, verifying that your pharmacy, doctors, and durable medical equipment providers such as Howard’s are in-network and going over your current year deductibles so you can plan your cash flow. Taking these five minutes at the beginning of the year can spare yourselves hours and sometimes hundreds of dollars in out-of-network charges.

In 2015 the Medicare deductible is $147.00.  Other insurances have different deductibles and you need to be aware of where your requirements are.  With the Affordable Care Act, we have seen deductibles as high as $12,000 for a family plan.  This means that an individual must pay out-of-pocket expenses of $12,000 before any insurance kicks in if you fall into this category.

One more thing is just because you have a deductible, the regular insurance requirements for an item (valid prescription and justifying chart notes) usually need to accompany the order. As an example, you need PAP supplies such as a mask, headgear and tubing, when you come to Howard’s you will still need a valid prescription before picking up these items.  Some insurances also require a valid sleep study as well!  If you are confused or have any questions, give our store a call and we will walk you through the process. One of the advantages of doing business locally in the Yakima Valley is we are here to help you and walk you through the process.  We are here to call your doctor’s office for you to help you get the right paperwork so you can get the supplies you need to have a healthy and happy year.

Happy New Year from Howard’s Medical where we are looking forward to having our family serve your family’s healthcare needs in 2015.

Yakima medical supplies. CPAP, Oxygen and Wheelchairs