Hopeful about the PAOC? Not Exactly, Says Pride's Johnson

BALTIMORE — CMS has finalized the agenda for the first meeting of its new Program Advisory and Oversight Committee, established to advise the agency on competitive bidding.

Set to convene Thursday, the PAOC will look at the online bidding system for the program, which was plagued with problems in Round One, along with financial documentation, another area providers say caused numerous unwarranted disqualifications in last year’s bid. Discussion will also include legislative requirements under the Medicare Improvements for Patients and Providers Act, licensure, accreditation and subcontracting requirements, new supplier issues and mail order for diabetic testing supplies.

A tentative timeline for the bidding program, released Friday by CMS, also will be outlined.

It’s a full agenda, but the one-day meeting still doesn’t include “some of the things it should,” according to Seth Johnson, vice president of government affairs for Exeter, Pa.-based Pride Mobility Products and a member of the first PAOC. Last October, CMS unexpectedly ended the term of the previous PAOC and formed a new 17-member panel chaired by John Blum of CMS and Tom Jeffers of Hill Rom. (See “Call for New PAOC Puzzles Current Members,” Oct. 13, 2008).

“One of the things that is absent is any opportunity for the PAOC members to talk about their experiences going through the program last year,” said Johnson. “They are the industry experts identified by Medicare, and they are the ones who can talk about the changes that need to take place to improve the program prior to any restart later this year.”

While there is a 45-minute public comment period built in at the end of the meeting day, that’s not enough time to detail the program’s “significant flaws” and talk about how to correct them, Johnson said.

He pointed out “they only gave a half-hour to the online bidding system, when there were a number of issues with that system last year.” That issue alone needs to be a substantial discussion, he said. “I would like to hear an overview from CMS as to exactly what improvements they have made to address the problems, and I don’t see how they can do that in half an hour.”

Johnson said he would also like to hear from CMS “what their plans are to Beta test the system so we don’t see the same types of errors come up again” during the bidding window.

“Another controversial issue and a very important subject that needs a lot of discussion is financial documentation,” Johnson continued. “One of the most surprising changes is that they have reduced the amount of financial information providers are required to provide from three years down to one year. Maybe CMS’ perspective is that due to the many disqualifications from last year that limiting the documentation will fix that problem, but there are a lot of concerns about requiring less information rather than more.

“When you look at some of the winners last year,” he noted, “especially in some of the MSAs where you saw the most provider reduction, there are lots of questions about bidders being qualified to provide the products and services that did win and a lot of qualified providers that did not win. I would think they would strengthen these requirements for bidders, not relax or weaken them.”

After potential irregularities turned up among power wheelchair bid winners in the Riverside, Calif., bidding area, for example, Pride called for an investigation into the matter. Johnson said last September, his company got an acknowledgement from CMS that it had received the information but has heard nothing since. Four California congressmen who called for an investigation also have not received a response, “which is very disappointing,” Johnson said. (For more, see “Pride Calls for Investigation in Riverside CBA,” May 5, 2008.)

“Before any restart of the program, there needs to be a full and independent analysis conducted of all of the issues that were identified and any problems with bidding from last year, and those issues need to be resolved in an appropriate manner,” he said.

One good thing, Johnson said, is that providers and others who don’t get to attend this week’s PAOC meeting in person have a 30-day period in which to submit written comments about the presentations provided by Medicare and its competitive bidding contractor (Palmetto GBA) during the meeting.

In it previous incarnation, critics of CMS’ Round One implementation said the PAOC was misnamed: While its name indicates the committee members had oversight powers, they did not, and while they were to function as well in an advisory capacity, CMS seldom took their advice.