Columbo and CMS

Thursday, August 31, 2006

I had an interesting phone interview with several CMS officials last month, even if they did leave me feeling a little lightheaded.
I had called CMS to ask a few questions regarding Medicare's proposal to revamp oxygen reimbursement. We started the interview, it seemed, speaking different languages.
At first, I thought it was my delivery. I'm sort of the Columbo of reporters. Remember how actor Peter Falk's trench-coat detective stumbled and bumbled his way through an investigation? That's how many of my interviews go. I start and stop, go this way and that, circle back, rephrase for clarity, appear baffled at the answers I get, and then ask more questions. Nevertheless, in the end I usually get the information I need. Just like Columbo. With that in mind, it didn't surprise me when the CMS officials answered many of my questions with a wall of stony silence. Maybe they don't understand I thought, and then rephrased the question. No, they understood. But when it comes to answering industry arguments regarding specifics of draft proposals, CMS no can do. Something about a law, they said.
A couple of examples:
HME News: Do you really think an HME can deliver oxygen content for $55 following the 36-month cap? Most providers don't think that is enough.
CMS: We can't answer that. Submit it as a comment.
HME News: The industry recently released a study showing that services make up 72% of the cost of providing oxygen. What do you think of that?
CMS: That is running into what we look for in the comment period. We don't want to say we take it seriously or that we don't take it seriously. That we laugh, throw it in the trash or whatever. This is comment and that comes to us for our review as part of our preparation for the final rule.
Drats! At this point, I began to think they'd picked up on my Columbo routine and were throwing it back at me. I sat speechless for a moment, not knowing what to ask or what not to ask.
Fortunately, the CMS officials did provide some insight into their thinking. For example, unlike providers, CMS officials believe beneficiaries will be able to care for their own oxygen equipment once they take ownership of it following the 36-month cap.
"The equipment is built in a way that it provides all kinds of safety alarms and mechanisms for the beneficiary to be aware that there could be a problem," a CMS official said.
Finally, I asked if, given all the reimbursement cuts to DME over the past two years, do they feel competititive bidding will still produce significant savings? They said this:
"The law gives us the authority to exempt items from competitive bidding if we determine the programs are not likely to result in significant savings. Of course, we would have to have data that would convince us there is not likely to be significant savings. And that is all I can say."
Believe me, Columbo couldn't have said it better.