Competitive bidding: Special forum frustrates listeners

BALTIMORE - A May 23 Special Open Door Forum on national competitive bidding (NCB) drew a staggering 600-plus callers, but the usefulness of the 90-minute forum was debatable, largely due to technical difficulties. "We can hear well when callers ask questions over the phone, but we can't hear you in Baltimore," The VGM Group's Don Kovach told CMS officials. "Maybe we could do a repeat?" After a handful of callers made similar pleas, officials said they would release a summary fact sheet on NCB. Officials did so on May 24. But that concession didn't satisfy everyone. Another caller commented, "I realize you'll post a summary, but the poor volume and audibility is limiting participation." The forum's goal was allowing stakeholders to provide feedback on CMS's 203-page proposal for NCB. The proposal, published in the Federal Register May 1, outlined the agency's plans for carrying out NCB for certain DME, orthotics and enteral nutrition. CMS accepted comments until June 30. The bulk of the questions asked at the forum came from callers who wanted to know whether competitive bidding could apply to them. A home health agency that dabbles in DME? Yes. A skilled nursing facility that provides enteral nutrition? Yes. A pharmacy that provides common DME like glucometers? Yes. A certified hand therapist who providers custom orthotics? No. Only off-the-shelf orthotics will be up for competitive bidding, a CMS official said. A caller who owns an orthopedic hand surgery practice in California was dismayed when CMS officials told him that competitive bidding could apply to him because he provides off-the-shelf orthotics to beneficiaries before they have surgery. "You really need to take a look at therapeutic issues, because this is an area of regulatory overkill," the caller said. "There really needs to be an exception made for very small providers, specifically for physician situations like mine." There were also several questions about a provision in the proposal that would allow smaller providers to form networks and submit collective bids. (CMS proposes that, when added together, the network members' market share for a competitive bid item cannot exceed 20% of the Medicare market within a competitive bid area.) One caller asked: How do providers form a network and avoid divulging proprietary information and collusion? A CMS official said this was an area where the agency sought comments. Toward the end of the forum, a caller asked whether it was a misprint that, in the proposal, CMS estimates the industry will lose about half of its providers, as a result of NCB. "You're referring to the impact analysis portion of the proposal," a CMS official said. "Those are the estimates we made based on demonstrations" in San Antonio, Texas, and Polk County, Fla. Another nugget of information from the form: * CMS issued a solicitation for Competitive Bidding Implementation Contractors (CBICs) on the Web site of the Federal Business Opportunity May 16. The CBICs will educate providers, solicit and evaluate bids, and perform other duties needed to support implementation.