PAOC Members Ask CMS for Specific Info on Round 1

WASHINGTON — In a May 6 letter emailed to CMS Deputy
Administrator Jonathan Blum, a dozen members of the Program
Advisory and Oversight Committee asked for the release of
additional data on competitive bidding.

The PAOC was formed to advise CMS on implementation of the
bidding program, but committee members have long said the agency
seldom takes its advice.

At a PAOC meeting
April 5, CMS officials gave what attendees described as a
“rosy” picture of Round 1 since its January 1 rollout. But after
the meeting, PAOC member Walt Gorski, vice president, government
relations, for the American Association for Homecare, said, “There
seems to be a very large disconnect that CMS has no problems.”

Copied to CMS Administrator Donald Berwick and Marilyn Tavenner,
principal deputy administrator and COO, the letter follows in its
entirety:

Dear Jon,

The undersigned members of your Program Advisory and Oversight
Committee (PAOC) for the DMEPOS Competitive Bidding Program are
writing you today to request that the Centers for Medicare &
Medicaid Services (CMS) disclose additional data points which we
feel are essential to our role of timely and accurately advising
CMS in determining if the bidding program is operating
effectively.

In order to fulfill our duty as PAOC members, we request that
CMS provide the following:

• For better clarity to demonstrate there are no adverse health
  effects, please provide the current tracking of the percentage of
  beneficiaries accessing DME (e.g. the charts presented at our April
  5th meeting), but expressed as a percentage of beneficiaries
  purchasing or renting the category item during the previous 12
  months (trailing 12 months). We request quarterly updates of this
  data.

• To better understand the impact of the Round One Re-Bid
  implementation on CMS’ call center, please provide tracking of the
  inbound 1-800-MEDICARE calls within the nine CBAs, using area codes
  to approximate the CBA boundaries, for January through March, 2010
  and 2011, to include data on number of calls presented, the number
  of lost/dropped calls, average time to answer by live operator,
  average talk time, and any available data on tracking resolution of
  the call (a standard in call centers).

• To plan for optimal beneficiary service needed within Medicare’s
  call center upon Round Two implementation, we request CMS address
  the following:

  • At our April 5th meeting it was reported there were nearly
    54,000 inbound calls for competitive bidding issues from January
    through some point in late March, 2011, and that 75 percent of
    these calls were related to diabetes testing supply products.

  • Extrapolating this to 91 additional CBAs, including our
    country’s most populous communities, CMS can anticipate a dramatic
    increase in queries, totaling more than one million additional
    calls in less than a three-month period following implementation of
    Round Two.

  • We would like to know the CMS call center statistic on average
    calls answered per agent per day for the period January through
    March, 2011. With this in mind, how many agents might be required
    to fulfill this need? What is the staffing level today?

• Diabetes test supplies were bifurcated between the mail order
  (included in CB) and retail (excluded from CB) markets. Please
  provide, by month and cumulative, the quantity and percentage of
  diabetes test strips (A4253) within each of the CBAs, and in total,
  provided via mail order (KL modifier) and non-mail order, for 2010
  and 2011. A shift to retail costs Medicare and beneficiaries as
  much as 279% more, almost four times, than the competitively bid
  Single Payment Amount.

• A goal of CMS in the Round One Re-Bid was to ensure multiple
  suppliers and beneficiary choice. Please provide PAOC members with
  quarterly updates, by CBA and by product category within each CBA,
  for the following:

  • The number of contracted suppliers at 1/1/11,

  • The number of the 1/1/11 contracted suppliers, above, which have
    closed and/or surrendered their provider number,

  • The number of the 1/1/11 contracted suppliers, above, which have
    provided no service in the CBA since 1/1/11,

  • The number of currently remaining and active contracted
    suppliers, and

  • The number of any contracted suppliers added since 1/1/11.

Such data should be easily accessible given the extensive
tracking system CMS has in place for this program. With time of the
essence in preparing for Round Two, we would appreciate receiving
this information no later than May 31, 2011.

Again, thank you for empowering PAOC members to provide the best
possible input and advice to CMS for effective and efficient
implementation of this Program, and we look forward to our next
PAOC meeting with you.

Very truly yours,

Peter Amico, Prime Care Medical Supplies Inc.
Doran Edwards, M.D., Advanced Healthcare Consulting LLC
Sue Elhessen, M.D., Careers Unlimited Inc.
Walter Gorski, American Association for Homecare
Jeffrey Mansell, Texas Department of State Health Services
Sharad Mansukani, M.D., NationsHealth Inc.
Thomas Milam, Tatum LLC
Wayne Murphy, The Joint Commission
Rita Hostak, Sunrise Medical Inc.
Thomas J. Jeffers, Hill-Rom Inc.
Barbara Rogers, COPD Association
Esta E. Willman, Medi-Source Equipment & Supply

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