Commentary: ‘According to CMS, Everything Is Coming Up Roses’

By Sean Schwinghammer, executive director of the Florida
Alliance of Home Care Services and advisor to the Accredited
Medical Equipment Providers of America

[On Wednesday and Thursday], AMEPA and FAHCS members attended
CMS hosted events for beneficiaries and caregiver groups regarding
the implementation of the competitive bidding program. The
two-hour sessions followed the same format; professional staff from
Atlanta and Baltimore gave their history of the bidding program and
tried to explain technical aspects of what will happen to
beneficiaries and ways to solve suspected problems in the program’s
initial implementation.

The events both consisted of about 40 attendees (case managers,
hospital discharge officials, Medicare counselors and some
suppliers.) There were approximately 10 CMS or CBIC staff at each
meeting.

Meeting

The officials who spoke were Renard Murray, Sabrina Teferi and
Teresa Zayas all of CMS’ Atlanta office, Tangita Daramola of CMS
Baltimore and Letisha Davis of CBIC.

Speakers reviewed the CMS policy and history of the program,
outreach activities to inform patients, grandfathering, traveling
beneficiaries, non-contract suppliers, use of specific brands and
deductibles and co-insurance. The Ombudsman spoke about concern
with the program’s implementation and helping deal with initial
issues.

The tone of the meetings was cautious confidence from CMS. They
touted the great savings that will be afforded the Medicare program
from the providers and savings to patients, but there were repeated
references to possible issues of concern and the need to
communicate with CMS as problems arise.

In general CMS’ cautious tone was very different from meetings
two years ago, when uncontained confidence resulted in problems
that justified the program’s delayed start.

Reality

There was no new information; the meetings are geared for
beneficiary support groups so it was a global perspective on the
program. It was frustrating to hear the commentary, but not be able
to ask questions. CMS officials from Atlanta [continually touted
the demonstration project] for its great success. Unfortunately
they did not discuss its down side: closed businesses, lack of
service, etc.

They barely touched on the failures of the program in 2008. No
one in the room was made aware of the low bids from out-of-area
providers, the inability for patients to find service, the problems
for discharge personnel and the unsustainable cuts for local
providers, etc. All of which will be repeated to the detriment of
the beneficiaries.

During breaks we spoke to case managers who raised serious
concerns for patients about access to care and proper equipment and
raised the reasonable concern “who will work at those rates.” It
was obvious that caregivers are not pleased with the program, but
there was no way to voice those concerns at the meeting.

Throughout the meeting attendees were told that there would be a
question-and-answer session at the end. All questions were to be
written on index cards and handed in. When the Q and A period
began, we were informed that they were out of time. With over 40
index cards of questions in hand, they answered only four related
to dual enrollment and they confirmed the possibility that hospital
officials will likely need to gain equipment from multiple
suppliers which could cause delays.

That comment generated a gasp from hospital administrators.

It was more than frustrating for everyone who really came to
have questions answered, more than to be lectured to about the
value of the program. Even though CMS claimed they had to give up
the room and close the session, officials and interested people
spoke in the same room for 45 minutes afterwards,
uninterrupted.

To their credit, CMS officials did say they would answer every
question asked, in writing and online, sometime next week. We hope
that will be the case.

CMS released new literature about the bidding program and said
that the names of the winning providers and the information
essential for beneficiaries to know will be released in
mid-October.

Future

Today CMS can report to Congress they have had successful
meetings with beneficiaries, when what they should report is that
they had controlled meetings where no input could be given and
where relevant questions were not answered.

At future meetings — in Rock Hill, S.C., on Aug. 24;
Charlotte, N.C., on Aug. 25; and Orlando, Fla., on Aug. 30 —
it is important to attend, to try to ask questions and to make sure
your concerns are known. Not just to CMS but the assembled case
managers and discharge personnel.

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