• He Said, She Said: Competitive Bidding Standoff

    From: Home Care Magazine

    ARLINGTON, Va. — The American Association for Homecare reported last week there is a growing body of evidence about problems related to the Round 1 rebid of competitive bidding, among them:
    • Bankrupt bid winners;
    • Errors on the Medicare.gov website providing misinformation to beneficiaries;
    • Incorrect materials sent to beneficiaries outside of bidding areas instructing them to switch to contract providers;
    • Lack of required state licensure among some bid winners;
    • Long-distance providers among bid winners; and
    • Contract provider credit problems.

    “The association continues to collect examples of problems, and we are making people on Capitol Hill aware of those problems,” said AAHomecare’s Walt Gorski, vice president, government relations. “I think there are some very legitimate concerns just in the run-up to the start of competitive bidding, and if we aren’t able to stop the program and it does start in January, there will also be an effort to identify patient care issues if the program does become operational.”

    AAHomecare’s growing list of concerns comes on top of a warning to CMS from 166 top economists that the bid program will fail, a report from University of Maryland economist Peter Cramton that shows at least half or more of existing providers lost contracts in all nine product categories, and a newly released analysis from Invacare that found more than 20 percent of bid winners have some sort of questionable financial situation (see “Invacare Analysis Raises New Doubts about Bid Winners”).

    The points raised by the recent studies are those that the industry has been making all along, Gorski said. “We’ve been looking at capacity, we’ve been looking at the clearing price, we’ve been looking at transparency, and clearly CMS has been unwilling to share any of this information. Therefore, you run into issues such as what Invacare has found.”

    After announcing Round 1 reimbursements in July, CMS had said it would announce the list of contract suppliers in September. But that announcement didn’t come until November, when the agency revealed the names of the 356 winning providers.

    “Frankly, I thought the delay really showed where CMS said they were doing additional scrutiny of suppliers,” Gorski said. “With only 350 of them, I would assume that someone at CMS or its contractor would have gone out to every single one of those places and checked them out.

    “It’s inconceivable to me that we have the issues we have mounting now,” he continued. “Once referral sources start trying to call these places and aren’t able to get service or hear that ‘it’s not in my service area,’ unfortunately patient care is going to suffer.”

    But is anyone at CMS listening?

    “I think these issues have raised doubts toward the program,” Gorski said, “but at the same time, I do believe that the staff who created this program think it’s going to work.”

    That has resulted in a “he said, she said-type discussion,” Gorski said. “We believe the facts are on the side of delaying the start of the program so that providers in the initial nine areas are not permanently harmed. But CMS officials believe the program will work, so we are at a standoff.”

    What would it take to change those CMS officials’ minds? Gorski said that it will probably take independent verification of any problems with the program after its implementation. “You can only speculate so much,” he said, adding that “there is always skepticism” when any health care sector or industry claims problems.

    “In this circumstance, I do think we are going to see problems with faulty design,” Gorski said. “I would not be sleeping easy if 166 economists from every great educational institution around the world questioned the program that CMS designed.”

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