PAOC Members Ask CMS for Specific Info on Round 1

From: Home Care Magazine

Exactly how many contracted suppliers are there? And are they providing service?

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