Quality Standards Dominate Competitive Bidding Meeting

Baltimore

For months, a panel advising CMS on DME competitive bidding has stressed that supplier quality standards are key to a successful program. At the last Program Advisory and Oversight Committee meeting, panel members said CMS had listened well.

When the agency met with the 22-member panel Feb. 28 through March 2, it devoted nearly an entire day to discussing quality standards. CMS is expected to release a draft this summer detailing exactly what these standards will be.

“CMS is making a good-faith effort to implement quality standards,” said Cara Bachenheimer, vice president of government relations for Elyria, Ohio-based Invacare Corp. and a member of the PAOC. “Most of us have been arguing very strongly this needs to happen — or the bottom is going to fall out.”

The Medicare Modernization Act mandates that all suppliers, not just those taking part in competitive bidding, meet certain requirements to participate in the Medicare program.

Bachenheimer and other panel members say that if quality standards do not precede the bidding program, companies with the lowest level of service and lowest cost component could win, leaving players with higher standards and service levels as losers.

North Carolina-based RTI (Research Triangle Institute), a contractor assisting CMS with program implementation, used materials from current accrediting bodies to put together a preview of what the quality standards might look like.

The overview included company standards such as financial management, competency of staff, safety and management of patient records.

“[RTI] did their homework,” Bachenheimer said. “They hit all the key areas.”

Important points that need to be considered include looking at the supplier as a health care provider and at business operations, according to committee member Asela Cuervo, a Washington attorney representing the American Association for Homecare. “Is there an annual budget? Are employees given training? These are things you would expect to see in a good solid business,” she explained.

CMS said it will follow an aggressive timeline to finalize quality standards and choose accrediting bodies to enforce these standards — though most on the committee argued that the agency should recognize suppliers who already are accredited. “I think pretty much everyone was in agreement that CMS needs to look at a grandfather clause or transitioning policies,” said committee member Seth Johnson, director of government affairs for Exeter, Pa.-based Pride Mobility. The agency is giving “strong consideration to the possibility,” according to a CMS official.

For further information, including notes and presentations from past PAOC meetings, visit CMS’ DME competitive bidding Web site at www.cms.hhs.gov/suppliers/dmepos, and scroll down to “Medicare Competitive Acquisition for Certain DMEPOS.”

For more specifics on the proposed quality standards, see “Washington Wit & Wisdom” on page 74.

QUALITY STANDARDS

Next Steps:

• CMS will review PAOC comments and incorporate them into development of the final quality standards.
• A draft of the final quality standards will be released this summer for the PAOC’s review and final comments.
• CMS is expected to issue a regulation explaining how accreditation organizations can apply for “deemed status.” The agency expects to publish a list of approved accrediting bodies by the end of the year.
• Final quality standards are expected to be published early next year.