Home Care Magazine
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.