Editor's Note:

Reality Checkpoint

Providers must blast through CMS’s ‘reality distortion field’ when lobbying.

• By David Kopf
• Mar 01, 2012

I’m pretty sure that CMS’s leadership was inspired by Star Wars when it developed its sci-fi-esque position on the effectiveness of national competitive bidding. Specifically, the scene where Obi Wan Kenobi uses his “Jedi mind tricks” to convince some Imperial stormtroopers that, “These aren’t the droids you’re looking for,” despite the fact that the droids in question are plainly sitting right in front of them.

In case you need a reminder:

In NCB’s case, CMS is trying to convince Congress that, “This isn’t the impending disaster you’re watching unfold.” Despite the fact that we’ve been seeing signs of that disaster for some time. The first time around was with the re-bid of Round One of competitive bidding, which went so swimmingly that it generated hundreds of complaints to industry hotlines and webpages, but more importantly resulted in 54,000 of what CMS described as “inquiries” and only 43 of what it called “complaints.” Old Ben Kenobi would be proud; those weren’t the thousands of complaints we were hearing about.

And now, CMS has cranked up its “reality distortion field” yet again. Back in late January, University of Maryland economist and auction model expert Prof. Peter Cramton conducted an analysis of Round One data that resulted in a 165-page report showing that Medicare claims for HME covered by Round One of competitive bidding dropped by as much as 82 percent during in 2011. The reported also showed that not all Round One contract providers are filing claims, and that together with the drop in claims, the risk of death and hospitalization for beneficiaries would spike sharply. This was because the sharp drop in claims suggested a dramatic decline in access to care for Medicare beneficiaries living in Round One bidding areas who need home medical equipment and services. Serious stuff indeed.

So what was CMS’s response? On the eve of the American Association for Homecare’s Washington Conference, CMS released its own study, using what it called real-time claims analysis (of factors such as such as hospitalizations, length of hospital stays, and number of emergency department visits) to track groups of Medicare beneficiaries potentially affected by the program to show that its competitive bidding program has preserved beneficiary health outcomes. What a shocker, eh?

What makes the disparity between CMS’s and Cramton’s analyses so frustrating is that they both used CMS data. Given CMS’s lack of transparency throughout the process, and a completely unwillingness to find any kind of middle ground with the industry, as well as the 220-plus economic experts in bidding and auction models that Cramton convened to warn CMS that its program was fatally flawed, I’m taking CMS’s report with a very large dose of salt.

But what you or I believe is irrelevant in the fight for competitive bidding — it’s what lawmakers believe, and the job the industry faces in convincing lawmakers is a bad deal for everyone concerned — patients, providers, physicians and the taxpayers — has become that much more difficult thanks to CMS’s Jedi mind tricks. The industry can bring out its expert analysis, but CMS will trot out its own. It’s a null effect.

This is why I will reiterate that the one factor that will make the real difference in providers’ lobbying efforts is patients. They tell the real story that will truly resonate with lawmakers and their legislative staff. CMS can say one thing. HME providers can say another. But, when a patient comes into a Congress person’s local office, or meets with them on the hill, their frustrations and fears regarding the bidding program are more convincing than any spread sheet, pro or con. Politically involved providers must make it an advocacy priority to mobilize their patients if they want to ensure Congress sees through CMS’s reality distortion field.

 

This article originally appeared in the March 2012 issue of HME Business.