CMS’ Kuhn: We’re Thinking About Round Two Already

WASHINGTON

Speaking at the American Association for Homecare’s Legislative Conference last month, acting Deputy Administrator Herb Kuhn told the group that CMS is moving toward full implementation of competitive bidding and will enforce its final rule on the program — mandated by the Medicare Modernization Act of 2003 — as it stands.

“We’re thinking about round two already,” Kuhn said, adding that “what we learn in doing this first round will be absolutely essential for us as we make refinements for round two.”

Because CMS is working on a “fundamental transformation” from being a passive payer of claims to an active purchaser of health care, Kuhn said, the agency is looking for value in the dollars it spends. That means focusing on prevention, pay for reporting, pay for performance, transparency, cost-effectiveness — “and yes, it also means competitive bidding.”

While one provider said he thought Kuhn had done an “eloquent job of sugarcoating” competitive bidding, the message was not exactly what attendees at the association’s annual lobbying conference said they wanted to hear.

An estimated 225 providers and industry advocates traveled to the nation’s capital to push Congress for support of H.R.1845 and S.1428, companion bills that would ease some effects of the national bidding program.

The proposed legislation would allow qualified providers that had submitted bids to continue serving Medicare patients at the single-payment rates that are set.

In a question-and-answer period after Kuhn’s June 6 speech, a provider asked whether Kuhn favored the legislative efforts, telling the CMS official he thought competitive bidding would “bring this industry to its knees and as a result put in jeopardy the patients we serve.”

Kuhn responded that the agency has not taken an official position on the legislation. “What we’re committed to right now is implementing the MMA and the competitive bidding program as part of the law,” he said.

To another question on CMS’ view of shortening the current oxygen rental cap from 36 to 13 months, Kuhn answered, “Nothing’s changed on that … that’s still the administration’s position on oxygen right now. We’re part of the administration.”

And asked why power mobility was included in the first round of bidding — on the heels of massive coding, coverage and payment changes in the sector — Kuhn said CMS’ charge was to “really look at where the areas are we could have the greatest impact.” After reviewing the volume of power mobility claims, he said, “we thought that it was absolutely appropriate for [power mobility] to be included in competitive bidding.”

But many conference attendees complained that the bidding program is being rushed to implementation following a rule more than three years in the making. After release of its final rule April 2, CMS opened the first-round bid window on May 15.

If the current time frame for the program is maintained, providers pointed out, data from the first round of bidding won’t be analyzed before the second round begins.

Several attendees said they hadn’t really expected to hear anything different from Kuhn. “There are lots of questions about competitive bidding, and not enough answers and not enough time,” said one angry provider, who asked not to be identified. “I give Mr. Kuhn credit for showing up — that took some courage — but he’s lucky he got out of that room alive.”

Following its Legislative Conference, which culminated in 272 meetings with U.S. House and Senate offices June 7, AAHomecare said about two dozen new co-sponsors signed on to industry-backed oxygen and competitive bidding bills, including: 16 new co-sponsors for the Medicare Durable Medical Equipment Access Act of 2007, known as the Tanner-Hobson bill (H.R. 1845); one new signer for its Senate companion the Hatch-Conrad bill (S. 1428); and eight new co-sponsors for the Home Oxygen Patient Protection Act (H.R. 621). For information on the bills, visit www.aahomecare.org. To get contact information for legislators, go to www.usa.gov/Contact/Elected.shtml.