PAOC meeting 'light' on answers

Sunday, June 22, 2008

BALTIMORE - CMS continued to toe the party line at its June 16 meeting with the Program Advisory and Oversight Committee (PAOC) for competitive bidding.

"It appears CMS does not believe there are major flaws with the program," said Walt Gorksi, vice president of government affairs for AAHomecare.
"The meeting was light on problem-solving and just more of a description of what CMS is doing on various aspects of the program."

With an average fee schedule cut of 26%, nearly double the 12% to 15% cut the agency originally forecasted, Herb Kuhn, director of the Center for Medicare Management, told committee members he considers the program a success.

"Herb basically indicated that, from his perspective, regardless of a delay or not, CMS has met the Medicare Modernization Act of 2003 mandate," said Seth Johnson, vice president of government relations for Pride Mobility Products and a committee member.

Committee members arrived at the meeting armed with questions that ranged from how many networks bid (19 bid) and won (1) to why CMS hasn't been more transparent when it comes to financial standards.

Also raised: The issue of revised quality standards--they're still not finalized--and why CMS has not required accreditors to enforce those standards.

There is a lot of concern that some contract winners met a lower threshold than high-quality providers, said Johnson.

"CMS made it clear that they were confident that winning providers met all the requirements for competitive bidding," he said. "From an industry perspective, that does not provide the result we were looking for as far as applying quality standards based on the statute and letter of the law CMS is required to follow."

PAOC member Bill Popomaronis, vice president of long term and home health care pharmacy for the National Community Pharmacists Association, pressed agency officials on the small supplier definition.

"Their definition of $3.5 million in total Medicare and non-Medicare revenues means community pharmacies are locked out and made to compete against Apria-like companies," he said. "I asked them, 'How many pharmacies are winning bidders?' They didn't know, but I can tell you, the answer is not many."