Stakeholders criticize shortsighted CMS

They say the agency’s data is ‘grossly inadequate’ to assess impact of bid program
Friday, May 20, 2016

WASHINGTON – CMS took too narrow a view when it analyzed the impact of new payment amounts for HME using only one metric, industry stakeholders say.

The agency on May 17 released data comparing the rate of assignment of claims for DMEPOS items for the first four months of 2015, which were paid at the unadjusted fee schedule rates, to the rate of assignment of claims for the same items for the first four months of 2016, which were paid at the new partially adjusted rates. 

“They’ve taken one micro piece of data that doesn’t tell the story,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

On Jan. 1, Medicare began paying for HME in regional and rural areas based on a 50/50 blend of the current fee schedule rates and adjusted rates from its competitive bidding program. On July 1, it will base pricing 100% on adjusted rates.

Other key metrics that should have been included in CMS’s analysis, stakeholders say: the volume of claims submitted, patient outcomes data, and beneficiary complaints. A pair of bills, S. 2736 and H.R. 5120, which would push back the second phase of cuts, include provisions for more comprehensive monitoring of the program to understand its impact.

“CMS has no clue what’s going to happen and they should want to understand the impact,” Bachenheimer said.

As for the data CMS did analyze, stakeholders say the agency neglected to say whether the claims were for date of service or date received, meaning some of the claims for 2016 could have been paid at 2015 rates. The agency also neglected to say whether they included dual-eligibles, for whom providers must accept assignment.

Most important, analyzing only four months of data does not a hard conclusion make, stakeholders say.

“Fourmonths of claims is a ‘grossly inadequate sampling,’” stated AAHomecare in its analysis. “It is not possible to use such limited data and draw expansive conclusions as CMS did.”

The short timeframe also doesn’t take into account the likely possibility that the impact of the cuts hasn’t been fully felt by providers—yet, Bachenheimer says.

“I’d say it takes a business about a year to reconfigure, to go out of business, to downsize,” she said. “It’s not an instantaneous response.”

Stakeholders say they’ll use this latest data from CMS to bolster support for the two bills this week at the AAHomecare Washington Legislative Conference. The Senate bill has 27 co-sponsors; the House bill, introduced May 12, picked up an additional 15 co-sponsors last week, bringing its total to 59.