Quality Standards Central Topic at Competitive Bid Meeting

BALTIMORE–Supplier quality issues dominated conversation during
last week’s three-day meeting of a 22-member panel advising CMS on
DME competitive bidding. Members of the Program Advisory and
Oversight Committee spent nearly an entire day on quality
standards, which many have stressed are key to carrying out a
successful bid program.

According to several panel members, the meeting was the PAOC’s
last before CMS rolls out a massive proposed regulation on the
what’s, how’s and where’s of DME competitive bidding this summer.
Under the Medicare Modernization Act, bidding is slated to begin in
10 top metro areas in 2007. The upcoming proposal will detail how
these areas will be selected, how bids will be taken and how
winners will be chosen, along with the criteria CMS will use to
choose products for the bidding program.

Also mandated by MMA, suppliers must meet quality standards to
participate in the bid. Those standards, which will be enforced by
accrediting bodies, are still to be determined by CMS. The agency
plans to release the quality standards in a separate program
memorandum this summer.

“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.”

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.

A draft of what quality standards might look like was presented
to the committee by North Carolina-based RTI (Research Triangle
Institute), a contractor assisting CMS with program implementation.
The overview drew heavily from material used by current industry
accrediting bodies, including the Joint Commission on the
Accreditation of Healthcare Organizations (JCAHO), the Community
Health Accreditation Program (CHAP) and the Accreditation
Commission for Health Care (ACHC).

Proposed company standards focused on eight topics:
organizational structure; financial management; human resources;
patient and client management; assessment and evaluation of quality
standards; facility and patient environment and safety management;
ethics and rights; and information management.

“[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 business operation,
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–though some on the
committee argued that the agency should recognize suppliers who are
already 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.

According to a CMS official, the agency is giving “strong
consideration to the possibility.”

Dr. Don Vliegenthart, a panel member and medical director for
Sarasota, Fla.-based Hoveround, said the committee is urging CMS to
release a final rule on grandfathering soon, but added that
shouldn’t keep providers from holding off on accreditation plans.
“I think providers working in this business should be accredited
now,” he said. “Now that it’s part of the law, I don’t see what
you’d be waiting for.”

Beyond the discussion of standards at the meeting, CMS heard
from panel members on how to calculate payments and ways to ensure
small providers can participate in the bidding program. The agency
must determine whether small companies can bid as part of a
network, according to some panel members. For more input on the
issue, CMS officials said RTI will form focus groups of 40 to 100
small providers throughout the country.

For further information, including notes and presentations from
past PAOC meetings, visit CMS’ DME competitive bidding Web site by
clicking
here.