What is new data to lawmakers?

Friday, February 24, 2012

It was only a few hours into my workday on a recent Monday when a home medical equipment provider emailed me about a story in our HME News Wire on Prof. Peter Cramton crunching an impressive amount of Medicare data and coming up with the following conclusions (See stories on pages 1 and 4):

4That there has been a significant drop in the number of HME providers in each product category as a result of competitive bidding;

4That there has also been a significant drop in the number of submitted claims in each product category and in each bid area as a result of the program; and

4That there have been negative health outcomes in each bid area as a result of the program.

The email from the HME provider said:

Don't you think this is exactly what Medicare wants? They will spin this number to Congress and take credit for the program's success. Sorry to take such a dim view of things, but this fits the MO of CMS.

Dim view is right.

I mean, isn't this the kind of data that proves competitive bidding is bad news for small businesses (fewer HME providers), Medicare beneficiaries (reduced access to HME products and services) and the state of health care (increased rates of everything from hospitals stays to deaths)?

It is--and, unfortunately, as this HME provider intimates, it isn't.

Let me put it another way: It is for Cramton and HME stakeholders--and it isn't necessarily for CMS officials.

We know CMS officials see this data in a different light. They think it proves competitive bidding is good news for government (working with fewer providers means fewer administrative burdens and costs) and taxpayers (fewer claims mean fewer expenditures). I'm not even going to repeat what they think it says about Medicare fraud and abuse.

But what about Cramton's third conclusion: That there have been negative health outcomes in each bid area as a result of the program?

There seems to be less room for CMS to "spin" this, because, in the most direct way, it's about people. People receiving a sub-standard level of care due to an ill-designed program.

This is why a few HME stakeholders have told me that this data, in particular, more than any of the other data, will be what pierces through the politics on the Hill, because, at the end of the day, lawmakers are beholden to the people, or so they should be.

So to this HME provider with the "dim view" I'd say: This data-driven approach to gauging the impact of competitive bidding is huge, whatever the spin may be, because lawmakers like data, as evidenced by the way they grasp and never let go of OIG and GAO reports that say, for example, that Medicare pays four times acquisition cost for power wheelchairs.

The big question now is: What is this new data to them?