The leader in Home Medical Equipment Mergers & Acquisitions
Top 5 in Health Care Services Mergers & Acquisitions
Founded in 1998, The Braff Group has completed more than 375 transactions. According to LSEG, The Braff Group has repeatedly been ranked among the top 5 health care services mergers & acquisitions advisory firms.
Intelligent Dealmaking® is knowing the Home Medical Equipment industry as only a specialist can; most importantly the specific trends and developments that impact value.
Our Managing Director, Pat Clifford, has over 25 years of experience in the Home Medical Equipment space. So, we simply know more about how to turn a good deal into a great one.
The Braff Group has compiled the most extensive database of HME deals. With unmatched insights on valuation and trends, we work with our clients to pinpoint the very best deal at the very best time.
We are sell-side representatives only. We never represent buyers, so our clients never have to worry about us steering deals to “favored” parties.
YEARS & COUNTING
Shout-Outs for 2024
It’s become a tradition for our final digital ebook of the year to look both backward and forward — to review the year’s accomplishments, to reflect on the misses, to make plans for the year to come.
Turn to page 12 for “HME’s Road Ahead,” our survey of home medical equipment industry leaders and their thoughts on the topics we’ll be talking about intensely next year; reasons to celebrate 2024; and how they think the HME industry will fare in 2025.
And since I ask industry professionals to share their opinions, it seems fair that I do the same. So here are my answers to one of the questions I asked:
I’d like to give a personal shout-out to … the educators. Of course, that includes speakers at Medtrade, VGM Heartland, state association conferences, etc. These folks crisscross the country and survive on airport food while delivering presentations on topics from compliance to funding to policy to research, emerging technologies, and clinical best outcomes. They educate in person and online, and they share their expertise and time generously and graciously.
I asked story contributors to choose a venue for an industry event. My family’s home state of Hawai‘i was a popular answer.
But I also recognize educators who probably aren’t even aware of how they’re teaching and supporting patients and colleagues. Have you ever had a new employee shadow you? Have you acted, formally or informally, as a mentor to a younger or less-experienced colleague?
If you have, you’re an educator, too. Thank you.
Also, a shout-out to the advocates.
We have outstanding “professional” advocates — folks who spend so much time on Capitol Hill that they can make their way from a senator’s office in Dirksen to a representative’s office in Rayburn with their eyes closed.
But have you ever advocated for a patient? Have you ever explained Medicare’s appeals process to a beneficiary, or told beneficiaries that Medicare “Advantage” plans are required to offer home medical equipment coverage that’s equivalent to what traditional Medicare offers?
Have you ever spent a little extra time to explain — or explain again — a product’s features and functions? Have you ever provided additional resources, such as product brochures or the phone numbers and website addresses to patient or caregiver organizations? Have you recommended a YouTube channel or updated patients on new developments, such as this year’s Lymphedema Treatment Act?
Guess what? You’re an advocate. Thank you. You are making a difference. Let’s keep it up in 2025. HMEB
Laurie Watanabe, Editor lwatanabe@wtwhmedia.com @CRTeditor
November 2024
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HME Business (ISSN 1940-6479) is published 4 times a year, March/April, June/July, August/September, and October/ November, by WTWH Media, LLC., 1111 Superior Avenue, 26th Floor, Cleveland, OH 44114.
© Copyright 2024 by WTWH Media, LLC. All rights reserved. Reproductions in whole or part prohibited except by written permission. Mail requests to “Permissions Editor,” c/o HME Business, 1111 Superior Avenue, 26th Floor, Cleveland, OH 44114.
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‘There’s A Lot of Activity’ 2025 HME Forecasting: Mergers & Acquisitions
Why 2025 Is Shaping Up to Be a Big Year for the Home Medical Equipment Segment
By Bob Holly, Executive Editor
There’s a good chance of 2025 being a big year for home medical equipment (HME) dealmaking activity, according to industry insiders.
For starters, the strategic buyers that drove HME industry consolidation between 2017 and 2021 are ready to get off the sidelines, with their integration efforts near the finish line. Meanwhile, on the private equity side, investors have more dry powder than ever — and they’ll need to deploy it soon.
Michael Freeman, the chief business development officer for VieMed Healthcare Inc. (Nasdaq: VMD), has already seen signs of HME M&A picking up.
“There are a lot of suppliers out there, whether they’re right there with a bank or not, that are testing the market,” Freeman said in August at the HME Business FUTURE conference. “And I do feel there’s a lot of activity picking up, just looking at what’s coming across my desk now from the beginning part of the year to where I sit here today.”
Lafayette, Louisiana-based VieMed is a national provider of in-home medical equipment and post-acute respiratory health-care services. Freeman joined the company a couple of years ago after previously leading transactions in the home health and hospice industries for roughly two decades.
As for the transactions on his radar, Freeman is seeing a lot of activity for the smaller HME suppliers, but also the “Grade-A-type suppliers,” he noted.
“I feel like it’ll be a good back-end of the year,” Freeman said. “[The industry] may not close deals by the end of the year, but we’ll likely get deals under, hopefully, LOI [letters of intent] that roll into next year.”
Chaz Bauer, the director of health-care investment banking for Fifth Third Securities, likewise expects HME transaction volumes to rebound to some degree in 2025.
“The first half of 2024 has been what many … believe is kind of the trough or the bottom of that activity,” Bauer said at FUTURE. “For those of us close to it, we’re starting to hear and see assets coming to market — or getting ready to come to market in the near future. And so I think that gives us some encouragement that activity is going to be picking up.”
Fifth Third Securities is a registered broker-dealer and investment advisor that offers a variety of financial services and products.
The HME industry is not a ubiquitous market where companies, for the most part, only do one thing. Instead, it’s made up of several product and service areas, from bent metal and basic in-home
medical supplies, to complex respiratory equipment and more. Generally, there’s starting to be M&A activity across the board, Bauer said.
“It’s across categories,” he said. “Complex Rehab is active and will remain active. We’re seeing some things on the sleep side, the respiratory side, as well as CGM (continuous glucose monitoring) and diabetes. And there’s stuff out in the market in each one of those categories — mixed quality, but quality is starting to improve.”
VieMed: Taking an Inside Look
During FUTURE, Freeman offered additional details on what VieMed is seeing on the M&A front, and how inorganic growth fits into the company’s plans moving forward.
Broadly, VieMed has established a track record of expanding via organic growth. That’s unlikely to change, Freeman said, with organic growth remaining option number one on VieMed’s growth roadmap.
But the HME company is reviving its M&A engine at the same time.
“VieMed was founded on organic growth, and we’re going to continue to put a lot of emphasis on organic growth throughout the country,” Freeman said. “Two years ago, I joined the company. We cranked up our M&A arm, and we understand that there’s an additional value we can create by acquiring the right asset in the right market, where it makes sense.”
M&A typically falls into three buckets for VieMed: transformational platform deals, strategic tuck-in acquisitions and joint ventures.
“I’m looking at all,” Freeman said. “I’m casting a big net, but we’re being very selective on which targets we go after.”
The joint venture avenue is, perhaps, one of the most interesting ones for VieMed. Freeman previously worked in a similar capacity at LHC Group, one of the largest home health and hospice companies in the U.S. that’s now part of Optum.
Chaz Bauer (left) of Fifth Third Securities and Michael Freeman of VieMed Healthcare at the HME Business FUTURE conference in Nashville.
LHC Group made joint ventures a calling card for the business, and Freeman sees parallels to what VieMed can do in the HME space.
VieMed already announced its first health system joint venture earlier in 2024 in a deal with East Alabama Health.
“I put together a lot of joint ventures in the home health and hospice side. We’re also following that same model in the DME [durable medical equipment] space,” Freeman said. “There’s not a lot of health systems that still own their own DME. If they do, they may also have joint ventures already, or they may have sold them off a couple years ago. But there are still some out there.”
Additional considerations
HME dealmaking could also be buoyed by a more conducive overall macroeconomic environment for dealmaking.
The Federal Reserve recently announced a long-anticipated rate cut, which could make it easier for HME dealmaking. More cuts are expected, too.
“Our restrictive monetary policy has helped restore the balance between aggregate supply and demand, easing inflationary pressures and ensuring that inflation expectations remain well anchored,” Jerome Powell, chair of the U.S. Federal Reserve, said at a press conference.
Another positive development for M&A is the fact that some statelevel legislation placing more oversight on PE — especially in health care — is starting to fail.
California Gov. Gavin Newsom, for example, shot down a law requiring private equity firms and hedge funds to get approval from the attorney general’s office when buying health-care assets. HMEB
I put together a lot of joint ventures in the home health and hospice side. We’re also following that same model in the DME space .
— Michael Freeman
Resounding Success, a OpportunityMajor for HME Companies Is in Danger of Going Away
By Bob Holly, Executive Editor
As 2024’s end draws near, one of health care’s biggest success stories from the past five years finds itself in peril. That’s not great news for the home medical equipment (HME) industry, which could see a promising opportunity vanish.
The Centers for Medicare & Medicaid Services’ (CMS) hospitalat-home program, which began during the COVID-19 pandemic, is facing a potential expiration at the end of 2024. Initially introduced to help hospitals manage patient surges and provide care in patients’ homes, the program has remained in place with positive results, allowing hospitals to receive reimbursement for acute-level care provided outside of the traditional brick-and-mortar setting.
Despite strong support for the program, Congress has not yet implemented a permanent solution. Proposed legislation could extend the program for another five years, but it is still pending approval.
And that’s slowing continued adoption of hospital-at-home models.
This topic — delivering hospital-level care in the home and what it takes to do so — was discussed in depth at the HME Business FUTURE conference in Nashville in August. Speakers who participated in the conversation included Alex Hoopes, senior director of strategy and execution for Velocare, and Dr. Robert Moskowitz, the chief medical officer of Contessa.
“If there’s not a definitive payment [mechanism], people will sit on their hands and sit on the sidelines,” Moskowitz said at FUTURE. “And I think what we’ve seen up to this point, it was very helpful — tremendously helpful — for CMS to rapidly stand this up and give an opportunity to say, ‘Hey, we got some funding for it. Go ahead.’ Now, we’re just in a moment where it’s like, ‘Wait a second. I want some guarantees that this is where we’re going before we’ll do next steps.’”
Hoopes echoed those sentiments.
“I think the waiver drove the demand in the first place,” he said at FUTURE. “So without the waiver, there’s no kind of early renaissance of the hospital-at-home program.”
As of Oct. 10, there were 366 total hospital-at-home certification numbers granted by CMS, according to agency data. Overall, those 366 numbers are linked to 138 health systems in 39 states.
Hoopes’ organization, Velocare, is a division within the broader Cardinal Health (NYSE: CAH) network. Velocare was launched as a first-of-its-kind distributed supply chain logistical solution for health systems trying to set up hospital-at-home programs.
“The way the concept of Velocare came about was from some of the health systems that we worked with, who were starting to kick the tires on hospital at home, and they were used to Cardinal Health helping them make sure they had the right stuff at that site of care,” Hoopes explained at FUTURE.
Velocare officially worked with its first hospital-at-home patient on Oct. 24, 2022, teaming up with an Oklahoma City health system. As of August, it had expanded its hospital-at-home network to 18 health system partners around the U.S.
“It’s interesting, because you see a lot of variety in the way these programs are operated,” Hoopes continued.
Meanwhile, Contessa is a veteran in the hospital-at-home space. Initially built as a standalone company, home health giant Amedisys Inc. (Nasdaq: AMED) acquired Contessa for $250 million in 2021.
In addition to working with health system partners and payers to launch hospital-at-home models, Contessa also spearheads programs that deliver home-based palliative care services and skilled-nursing-facility-level care in the home.
As of the FUTURE conference, Contessa partnered with 10 large health-care systems across the U.S.
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“We started doing it under value-based arrangements with payers, … moving care to the home and taking risk with respect to readmissions and escalations back to the hospital,” Moskowitz said. “We had an intentional sort of path to — if we could figure out how to do hospital-level care in the home, then we can start doing the other parts of what we consider the patient’s longitudinal journey.”
The inflection point
The funding aspect of hospital-at-home had previously been a major sticking point to broader adoption. Another challenge has been the supply-chain component — ensuring that all the necessary equipment gets to where it needs to go, when it needs to be there.
It’s this challenge that has turned into an opportunity for HME players such as Velocare.
“In this model, you have to be extremely planful,” Hoopes said. Early on, some health systems may figure out a way to go it alone in setting up hospital-at-home models. But as programs grow from a single-digit patient pool to double digits and beyond, they often quickly realize they need help.
“When we got involved with some of these early health systems, we were typically engaging with health systems whose programs had gotten started, were growing, and then they were hitting an inflection point,” Hoopes said. “They had figured out a way to get their programs off the ground. They could support a census of maybe eight or nine patients at a time. But right as they were trying to cross over into double digits, that’s when the things that they had [pieced] together [started to see challenges].”
Lessons learned
About a month after the HME Business FUTURE conference, CMS released a fact sheet highlighting key takeaways from the hospital-athome program, which is technically titled the “Acute Hospital Care at Home Initiative” (AHCAH).
In addition to extending the hospital-at-home waiver, the Consolidated Appropriations Act of 2023 required CMS to study and analyze AHCAH.
When it comes to clinical conditions, patients in AHCAH were primarily treated for a relatively small set of conditions, according to CMS. The agency’s study found that the most common Medicare Severity Diagnostic Related Groups (MS-DRGs) and Major Diagnostic Categories (MDCs) treated through the AHCAH initiative included respiratory conditions, circulatory conditions, renal conditions and infectious diseases.
In terms of quality compared to traditional hospital settings, AHCAH had mostly positive results.
If we could figure out how to do hospital-level care in the home, then we can start doing the other parts of what we consider the patient’s longitudinal journey
— Dr. Robert Moskowitz
“The study found that beneficiaries who received care under the AHCAH initiative generally had a lower mortality rate than their brick-and-mortar inpatient comparison counterparts, consistent with existing HaH [hospital-at-home] literature,” CMS wrote in the study.
AHCAH also seemingly did well from a cost perspective.
Moskowitz likewise described the difficulties that come with jumping from a smaller patient pool to a larger one.
“It’s like, ‘Wait a second. Now, I’ve got issues,’” he said. “Whether it’s DME equipment, pharmacy getting sent to the [home], you know, labs, nurse scheduling, community paramedicine scheduling, etc.”
Hoopes offered some examples of the types of medical equipment patients need in the home. About 70% of the patients that Velocare works with, he said, need oxygen equipment. Another 60% of the patients the organization works with need IV infusion, he added.
Patients may also need suction-related equipment, various dressings and more.
“They’re kind of hitting that Goldilocks principle of patients having what they need, plus maybe a little bit more,” Hoopes said. “And we’re not going to put them in a position where they’re going to get pinched because they need something in the middle of the night, and it’s not there.”
A common misconception around hospital-at-home is that stakeholders are basically duplicating the brick-and-mortar hospital in the home setting. That’s far from the case, Moskowitz explained.
“The one thing you’re not doing is recreating the hospital in the home, because we know the problems that exist with a hospital,” he said. “So if you’re going to recreate the hospital in the home, you’re going to recreate those problems.”
”The analysis showed that AHCAH inpatient episodes had, on average, a slightly longer length of stay than comparable brick-andmortar inpatient episodes,” CMS wrote. “Additionally, there was, on average, lower Medicare spending for services furnished in the 30-day post-discharge period for AHCAH episodes, as compared to brick-and-mortar inpatient episodes, across more than half of the top 25 MS-DRGs in the AHCAH group.”
However, the differences attributable to AHCAH patient selection criteria and clinical complexity, as measured across the two groups, make it difficult to conclude that the AHCAH initiative resulted in lower Medicare spending overall as compared to brick-and-mortar inpatient care, according to CMS.
There are several health-care groups that want to see a more permanent CMS hospital-at-home program, with many signed on to the Moving Health Home coalition.
Whether or not that happens is still unclear, but there’s certainty momentum behind the cause, according to Moskowitz.
“Very, very rarely in the health-care industry do you have all your forces agreeing upon something,” he said. “You have health-care systems saying, ‘I have to find an alternative site of care.’ You have payers that constantly look for alternative sites of care, if the outcomes are right and the economics are right. You have patients … saying, ‘I want the alternative site of care, and I want to be my home.’” HMEB
Industry
leaders on this year’s highlights and lowlights … and how they’re feeling about 2025
By Laurie Watanabe
This is an introspective time of year, as sunsets come sooner and the days left on the calendar dwindle. It’s been a turbulent time for the home medical equipment (HME) industry, given the end of the 75/25 blended rate for Medicare reimbursement. But there have been triumphs as well.
We asked a range of industry leaders to assess 2024 and share their hopes for 2025.
As we look toward 2025, the issues most on my mind are … Rate relief continues to be a priority on both the state and federal side. Adjusting the rates from the failed bid program on the urban bid areas and getting the 75/25 relief back in regulation or legislation will be on the front burner.
We also are focusing our payer relations team on state Medicaid rate stability.
We will certainly be watching for any rulemaking on competitive bidding and continue to keep key product categories like CGMs [continuous glucose monitors] and NIV [noninvasive ventilation] out of the program if it moves forward. The Medicare Advantage challenges and growth in that part of Medicare will continue to require better oversight and transparency.
— Tom Ryan, president/CEO, American Association for Homecare (AAHomecare)
Reimbursement rates, to include restoration of the 75/25 blend, and increases from commercial payers. — Craig Rae, owner/ president, Penrod Medical
Revenue cycle management, AI [artificial intelligence] in health care. — Aileen Manalo, senior director/marketing, DME Service Solutions
The impact of mergers and acquisitions on the DMEPOS community and how it will impact the market from a patient access and cost perspective. — Judi Knott, president/CEO, Board of Certification/ Accreditation (BOC)
Helping HME providers bolster their bottom lines while also providing excellent care for their patients. We’ve heard about growing demand from the baby boom generation for a long time, and that demand is coming on strong. Reimbursements rarely go up, so providers need the right products, the right education, and a bit of inspiration. — Kerry Tyler, associate show director, Medtrade
Technology advances and increased utilization of technology from the provider and patient perspective, as it relates to education, remote patient monitoring, and e-commerce.
— Sandra Canally, RN, founder/CEO, The Compliance Team
Leveraging technology to increase efficiencies and allow our partners to scale and provide the best services they can to the patients who need it most. — Kyle Neese, senior account executive, ACU-Serve
Advocating for CMS [Centers for Medicare & Medicaid Services] oversight with Medicare Part C (Medicare Disadvantage). Titanium/ carbon fiber upgrade within [the ultralightweight wheelchair] code. Complex Rehab Technology (CRT) repair reform: Service what you provide. — Dan Fedor, director of reimbursement, U.S. Rehab
A high point in 2024 was … As a company, celebrating 30 years as a successful leader in the health-care accreditation industry would be the greatest high point.
— Sandra Canally, The Compliance Team
The CMS implementation of the Lymphedema Treatment Act. — Noel Neil, JM, CDME, chief compliance officer, ACU-Serve LLC
The telehealth extension through Dec. 31, 2024. — Dan Fedor, U.S. Rehab
Health-care players opening up to tech (AI). Aileen Manalo, DME Service Solutions
Coverage of power elevating seats for CRT equipment, which was long overdue. — Craig Rae, Penrod Medical
The work in both the commercial and Medicare Advantage sectors in medical policy improvements and utilization management has gained traction and has been a focus of new lobbying efforts on the Part C side with our engagement with Tom Barker and team at Foley Hoag. We have also seen rate improvements from our state efforts. We have grown industry recognition of ePrescribe and made headway both on the Hill and at CMS on the importance of this technology as another tool to combat fraud. — Tom Ryan, AAHomecare
And an industry low point was … Cyberattack on Change Healthcare. — Craig Rae, Penrod Medical
Congress’ failure to extend the 75/25 blended rate to suppliers. — Noel Neil, ACU-Serve LLC
CRT repairs — the right to repair and continued negative publicity for the industry when suppliers do not service what they provide. Department of Justice false claims settlement with Numotion regarding ATPs’ unethical and illegal involvement with evaluations — black eye for the entire industry … again. The 30% reduction in the seat elevation allowable by CMS with new code E2298.
— Dan Fedor, U.S. Rehab
We have grown industry recognition of ePrescribe and made headway both on the Hill and at CMS on the importance of this technology as another tool to combat fraud
— Tom Ryan, AAHomecare
I am likely biased, but Medtrade 2024 was a rallying point for the industry. The show has always mirrored the industry in many respects, and we experienced a significant attendance jump in 2024. Medtrade 2024 attracted more than 2,300 qualified attendees, and that number did not include exhibitors.
That amounted to an increase of almost 25% over 2023. While Medtrade is chock full of products/equipment and excellent educational sessions, much of its power comes from networking. Talking with exhibitors and colleagues is inspiring, and providers can use it as a springboard for a successful year. — Kerry Tyler, Medtrade
Stabilization from 2023 woes: recalls, supply chain, consolidation, etc.
— Kyle Neese, ACU-Serve
The end-of-year omnibus that looked to be including the 75/25 blended rate fix became a victim of politics and government dysfunction as we instead saw a series of shorter-term government funding efforts that didn’t include our Medicare extender and relief along with health-care sector priorities that didn’t make the cut. — Tom Ryan, AAHomecare
Price gouging. — Kyle Neese, ACU-Serve
It was rough when the so-called 75/25 blended reimbursement rates (enacted during the pandemic to help providers and patients) ended on Dec. 31, 2023. The fight to get those restored continues, and our partners at AAHomecare are working hard to hopefully make that a reality. — Kerry Tyler, Medtrade
Our famous Stella Rollator is loaded with many convenient features :
• Reinforced seat
• Lightweight at 14.75 lb (6,7 kg)
• Oversized height-adjustable backrest strap
• Height-adjustable handles with quick release
• Optional footrests, armrests and slow-down brakes
So often providers think that accreditation is a commodity, and all programs and AOs [accrediting organizations] are created equal. It’s just not the case. As an AO for 30 years, it’s frustrating that it’s still a way of thinking for some. — Sandra Canally, RN, The Compliance Team
A few words that describe how I feel about this new year are … Optimistic, excited and prepared. — Judi Knott, BOC
Optimistic, committed, responsive. — Kerry Tyler, Medtrade
Cautiously optimistic, determined, energized. — Kyle Neese, ACU-Serve
Optimism, progress, accountability. — Noel Neil, ACU-Serve LLC
Optimistic, passionate, determined. — Dan Fedor, U.S. Rehab
Challenges, opportunities, value of home care. — Tom Ryan, AAHomecare
Change is inevitable. — Sandra Canally, The Compliance Team
Rate relief critical! — Craig Rae, Penrod Medical
Damn, it’s 2025? — Aileen Manalo, DME Service Solutions
If I could pick any city in the world to hold an industry event, it would be …
Denver: centrally located with many direct flights, cool city, pre- or post-industry event, to spend time in the beautiful Rocky Mountains. — Dan Fedor, U.S. Rehab
I think Nashville is quickly become a good hub for health-care meetings. — Noel Neil, ACU-Serve LLC
Geneva. — Aileen Manalo, DME Service Solutions
We’re a relatively small industry, and there are numerous cities that are great for small events, to include San Antonio, Indianapolis, Denver, Tampa, Kansas City, and Scottsdale.
— Craig Rae, Penrod Medical
NYC has it all, but I may be thinking like a native New Yorker …. — Tom Ryan, AAHomecare
Nashville. — Kyle Neese, ACU-Serve
Pittsburgh; it’s my hometown and a wonderful place to visit, but also easily accessible and affordable. — Judi Knott, BOC
Maybe the city of Kapa‘a on the Hawaiian island of Kauai? However, airline costs would be prohibitive to say nothing of commute times from the East Coast. With that off the table, I’d say Dallas is ideal. ‘Fortunately that’s where Medtrade will be from Feb. 18-20, 2025. — Kerry Tyler, Medtrade
Honolulu, Hawai‘i. Need I say more? — Sandra Canally, RN, The Compliance Team
I’d like to give a personal shout-out to … Heather Ferguson, founder and executive director of the Lymphedema Advocacy Group.
Working collaboratively with industry stakeholders, [DME MACs] have been able to effectuate many meaningful changes
— Noel Neil, ACU-Serve
Her steadfast commitment and persistence gave birth to the Lymphedema Treatment Act. I believe her journey and her story are inspirational, and it should add fuel to the fire for all of us who are advocating for patients’ access to the appropriate clinical care.
If I can add one more, I would say the Medicare DME MACs. Working collaboratively with industry stakeholders, they have been able to effectuate many meaningful changes. — Noel Neil, ACU-Serve LLC
AAHomecare’s volunteer board and council leadership. They are dedicated industry experts who add tremendous value to our team and our mission. — Tom Ryan, AAHomecare
Laura Williard [senior vice president, payer relations] of AAHomecare. She’s led efforts to put countless dollars back into the pockets of HME providers throughout the U.S. — Craig Rae, Penrod Medical
Greg Packer for his years of dedication and passion for the CRT industry and his lasting legacy of improving access for those in need of CRT. — Dan Fedor, U.S. Rehab HMEB