CMS weighs in on bid data

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Thursday, February 2, 2012

BALTIMORE - No sooner had Prof. Peter Cramton released a report that showed 60% to 80% declines in Medicare claims for home medical equipment in Round 1 competitive bidding areas (CBAs), than CMS was dismissing the data.

At a Jan. 25 Jurisdiction C council meeting, Medical Director Dr. Paul Hoover said he hasn't seen any such decline in claims, according to Michael Hamilton, executive director of the Alabama Durable Medical Equipment Association, who attended the meeting. Hoover suggested that perhaps Cramton didn't ask "the right questions" in his Freedom of Information Act (FOIA) request for the data, said Hamilton.

"He said if you don't ask the right questions you get misleading data," he said. "It seems to me it would be a pretty simple process for somebody as experienced at statistics as Cramton must be."

In addition to Hoover, CMS officials have acknowledged "some decline" in claims; they attribute it to reduced Medicare fraud.

When contacted by HME News, CMS officials wouldn't specify a percentage decline in claims or explain why they believe Cramton's report is flawed. It did release a comparison of allowed charges in CBAs versus non-CBAs as proof that the program is necessary to reduce fraud. According to CMS: In Miami, which has 517,370 fee-for-service beneficiaries, there were allowed charges of $221,660,443, or $428.44 per beneficiary; by contrast, in Chicago, which has 1,085,254 beneficiaries, there were allowed charges of $173,922,952 or $160.26 per beneficiary.

Some industry associations are asking the Government Accountability Office (GAO) to investigate the "anomaly" between Cramton's and CMS's conclusions.

"They're using the same data and both sides can't be right," said Wayne Stanfield, president and CEO of NAIMES. "We have no reason to believe that Dr. Cramton would jeopardize his reputation by putting out something that he did not have ultimate confidence in."

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Comments

Until CMS produces a detailed, data driven analysis that is transparent, then their denials ring hollow.<br />
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If CMS states that Cramton is so clearly wrong, then they should have no trouble providing facts to back up their statements.

What a coincidence that both Miami and Chicago have exactly the same amount of allowed charges ($221,660,443).<br />
Are you sure this isn&#39;t a typographical error?

Nice catch, Bob. It&#39;s been corrected. Theresa

All we know for sure is that spending went down. As far as I can see, neither CMS nor Crampton have shown any facts to prove their points. (Dollars spent per beneficiary again just shows that fewer customers are being served. It doesn&#39;t demonstrate that they do or do not need the services that are being paid for by Medicare.) That said, I find the drop in the number of claims to be as worrying as Crampton is.

I&#39;m amazed there&#39;s been no comment here on today&#39;s WSJ<br />
editorial.

When someone from Capitol Hill&#39;s mother who is on Medicare needs a walker, is provided one from a manufacturer oversees produced in a cave, the walker falls apart she ends up in the hospital with a fx hip, comes home needs a wheelchair which is also made in a cave, the back wheel falls off as they are transfering her to the electric hospital bed, which was also made in a cave, get her in bed and the junction box catches on fire as she uses the pendant, tries to call the homecare company after hours but they went out of business because they only received 20% of the referrals in comparison to last year, then Capitol Hill will realize that competitive bidding is costing the system more money with increased hospitalizations and lack of access to quality HME dealers. We are a service industry not Commodes R Us!

Stop the presses! CMS thinks they are right and their critics are wrong yet offers no proof or transparency to back up their side.....film at 11. :P

CMS IS USING NCB TO GROW AND PROSPER, LIKE MOST GOVERNMENT AGENCIES, TAKING JOBS FROM THE PRIVATE SECTOR. CMS IS SELF SERVING WITH NO ACCOUNTABILITY. DO NOT EXPECT THE TRUTH, THEY CAN&#39;T HANDLE IT!

On my patient satisfaction survey&#39;s there is a question that says "Do you feel your medical equipment kept you from unnecessary hospital stay or nursing home admission" The answer is 100% yes. Have been compiling my own data for years. However it falls on deaf ears. Law makers point the finger to CMS and CMS points the finger back onto the "Law". We have seen that gov&#39;t agencies can be just as corrupt as any other corrupt business. So what&#39;s the deal? Release the numbers, or do they have something they are trying to hide? The competitive bidding program is a f&#39;ing disaster. WAKE UP AMERICA!

We are rank amateurs in trying to play this â&euro;œInfluence Congressâ&euro; game when we go up against the mighty engine that is CMS. Those guys live up there and have made a career out of making reality of what they want to accomplish. They are not popular with Congress, but they are effective and know their business.<br />
What they have done with their â&euro;œevidenceâ&euro; is to hide reality amongst the statistics. Remember, â&euro;œFigures donâ&euro;™t lie, but Liars figure.â&euro; For example, if you had a great increase in murder and crime in one small area of a big city and you threw the Numbers into the overall crime stats for the city or state you would see little if any change in the crime rates. But you would be missing/hiding a very real problem in that specific area of the city. There may be a serial killer or gang activity that affects the citizenry of that spot on the globe. This problem would not be reflected in the numbers.<br />
Here in the world of DME/HME I sense the same problem in â&euro;œreporting the factsâ&euro;. Since DME/HME only compromises less than 2% of the budget, any significant affects from changes in ER Admissions, Death Rates or Hospitalization from DME/HME problems will be impossible to see in the Big Picture. Does this mean there is not a problem in access to care and quality of care? The problem is in how we look at (or donâ&euro;™t look at) the situation.<br />
This needs to be shared with your Representatives and Senators. Magic at the end of the day is not Magic. It is just misdirection and sleight of hand. That is what we have here â&euro;“ Something that looks believable and amazing, but is not true. <br />