CMS Goes Fact-Finding in Four CBAs

ATLANTA — A CMS contractor has been hosting focus groups
to gather information on how competitive bidding‘s been going
so far. A select number of home medical equipment providers and
referral sources have been invited to attend the sessions, held in
four of the nine Round 1 competitive bidding areas: Cleveland,
Dallas, Orlando and Riverside.

CMS contractor Abt Assoc. is facilitating the focus groups,
which come less than a month after the agency announced bid rates
that average a cut of 32 percent below current Medicare payments.
Abt’s history with CMS includes various contracts, among them work
on the 104-page draft of mandatory DMEPOS supplier quality
standards released in 2005.

Under congressional mandate, CMS must provide an evaluation of
the bidding program by July 2011, according to an agency
spokesman.

“The design of the evaluation study is a before-after design
(with comparison groups from non-competitive bidding areas),” the
spokesman explained. “The focus groups and/or interviews that the
contractor has been conducting (in July) in four competitive
bidding areas are for fact-finding and qualitative data collection
about market operations in the ‘before’ period. There will be
several other rounds of qualitative data collection as the program
proceeds.”

Not all those rounds will include focus groups. In addition to
the meetings, phone interviews will be held with individuals in
several cities not included in Round 1 for comparison purposes.

“Phone interviews are being conducted with several individuals
in each of the comparison areas (Houston, Tampa, San Francisco),”
the spokesman said. “The types of individuals include beneficiary
groups/advocates, referral agents and suppliers.”

In-person and/or phone interviews with the same types of
participants are also being conducted in the CBAs where the focus
groups were held.

“The information collected will be used to report on informants’
perspectives regarding the way the DME market operates in these
areas and changes they anticipate. Discussion topics include
referral processes; opinions about the state of access, quality,
and competition in the market; bidding process (for suppliers); and
knowledge of/expectations about impacts of competitive bidding,”
the spokesman said.

But much of this was unclear to some of those invited to the
groups.

Chris Rice of Riverside, Calif.-based Diamond Respiratory Care
said he attended his area’s focus group along with five others.
“Sadly, one or two of the people there had no clue and thought they
were there to receive information about the program,” he said.

“This was a mix of bidders, non-bidders, winners and
non-winners,” Rice said, adding he did not know how anyone was
chosen. “One lady did not bid, one guy wasn’t even in the bidding
area.

“The questions they were asking seemed to me to be to get the
lay of the land, our impressions of the local market,” Rice said.
“They asked questions about the bidding process itself. They wanted
our opinions on the user interface, the education that led up to
the bidding process, how we found out that there was a bid to begin
with.”

Rob Brant, president of the Accredited Medical Equipment
Providers of America, said a business colleague attended the
Orlando focus group and reported that eight people showed up.
“After a discussion, a case manager from the Orlando Regional
Hospital system said, ‘This is very confusing; just tell me which
company won every category so we can just call that company,’”
Brant said.

The focus groups took industry stakeholders by surprise. Some
voiced concerns about what Abt was looking for and how CMS would
use the information.

“This is another example of things we shouldn’t be guessing
about,” said Jay Witter, senior director of government affairs for
the American Association for Homecare. “This is a government
process that should be open, and this is another example of why we
need transparency in the competitive bidding process. These are
taxpayer dollars. The administration wants open government and they
should give us these basic pieces of information, like, ‘We’re
going to conduct focus groups and here’s who we’re inviting,’”
Witter said. “We shouldn’t have to speculate about it.”

Questions such as how participants were selected to attend the
focus groups, whether or not a report will be issued and who will
produce the report need to be answered, Witter said.

The issue added to AAHomecare’s concern about transparency in
the bidding program. Early last week, the association called on the
administration to hold CMS to the president’s pledge of open
government.

“One program severely lacking in transparency is the Medicare
bidding program for home medical equipment. It is hard to assess
whether the massive problems that arose in the 2008 bidding program
have been corrected in this round when CMS is providing no details
about which companies have been offered contracts following the
recent rebidding,” AAHomecare said. The association said it is
“pushing CMS to release the list of companies that received
contract offers.” (For more on the original Round 1, see “It’s
Official: Round 1 Had Lots of Problems,” Dec. 10, 2009.)

AAHomecare also noted that concerns persist about “what
financial standards — if any — were applied to bidding
companies, whether CMS has ensured that all companies offered
contracts are licensed in their states, and whether the bid winners
will be able to adequately serve the seniors and people with
disabilities in each bidding area.”

Whether or not Abt got a whiff of the industry’s worries about
the bid program through the focus groups remains to be seen, but
AAHomecare and industry groups including AMEPA, VGM, NAIMES and
others are pushing providers to continue fighting for the
elimination of competitive bidding.

“Don’t hang up those gloves!” VGM wrote in a message to its
members last week about Congress’ upcoming August recess. “We can’t
give up the fight yet! Now is the time to begin scheduling
appointments with your representative and senators to meet with
them over the August recess. It is crucial to continue
conversations about ‘competitive’ bidding and the need to repeal
it.”

Currently, H.R. 3790, the bill authored by Rep. Kendrick Meek,
D-Fla., is the only mechanism the industry has to stop the program.
As of Friday, the bill had 254 cosponsors.

View more competitive bidding
stories.