Stakeholders push new bid data

Thursday, January 26, 2012

WASHINGTON - Industry stakeholders last week were still getting their arms around Round 1 claims data released by Prof. Peter Cramton, but early reaction was that it was powerful stuff.

"We are certainly talking about it on the Hill," said Cara Bachenheimer, senior vice president of government relations for Invacare. "It tells a very interesting story and if people aren't wanting to ask more questions and get more answers, something's wrong."

The data shows that the number of claims submitted in Round 1 bid areas plunged by as much as 82% in 2011 compared to 2010. Cramton obtained the data through the Freedom of Information Act (FOIA). 

But could CMS, which has long touted the competitive bidding program as a tool to reduce fraud, counter that the figures point to a decline in fraud?

"To infer that a 60% or 70% decrease in utilization is a result of (a decrease) in fraud, one would have to assume that there has been a massive conspiracy between physicians and homecare suppliers," said Walt Gorski, vice president of government affairs for AAHomecare. "That's a jump that even Evel Knievel couldn't make."

Stakeholders say CMS, which hasn't commented publicly on the data, believes it is flawed. Still, they have confidence in what it shows.

"We can take this to be a preliminary warning sign that it appears there are access issues in the nine CBAs," said Gorski.

With a full Congress back in session, the data is spurring a renewed push for the market pricing program designed by Cramton and supported by the industry. Gorski, for one, would like to see that momentum carried forward to AAHomecare's Washington Legislative Conference on Feb 15-16.

"This is a make or break kind of visit," he said. "We've said that before, but it's really getting down to it."



The HME industry as long held the belief that any decrease in utilization would result in increased hospital admissions. Is there any data to verify that hospital charges for Medicare were trending upward?

No reasonable person could say that 74.1% of the diabetic supply utilization was fradulent. That is just laughable.