Numbers game

Saturday, August 31, 2002

WASHINGTON — A report that claims rolling out a national competitive bidding project would require a 35% increase in CMS's workforce has pit AAHomecare's Coalition for Access to Medical Services, Equipment and Technology (CAMSET) against CMS in the first round of what's becoming a heavyweight boxing match.

The CAMSET-commissioned report, "Regulatory Mandates Imposed Under the New Medicare Competitive Bidding Program," is the coalition's first rebuttal to claims that competitive bidding will save boatloads. The report says CMS would need to add 1,626 full-time employees to its payroll to manage a national competitive bidding project. That's a big boost, considering estimates that the current number of CMS employees dedicated to DME hovers at around 15.

"If they do this as a way of streamlining savings, it's a misguided approach," said Asela Cuervo, AAHomecare's senior v.p. of government relations and general counsel.

In the report, the Washington-based policy research firm Multinational Business Services lays out the support system it thinks is needed to roll out a national competitive bidding project based on Section 511 of the Medicare Modernization and Prescription Drug Act of 2002 and the two existing demonstrations. The hypothetical system creates 260 competitive acquisition areas (CAAs) across the country where competitive bidding would take place. Each CAA has its own bureaucracy, including bid management offices, public affairs offices and appellate divisions. Also included in the system are additional employees for CMS's regional offices and headquarters.

Mark Wynn, a senior social science research analyst with CMS, disagreed that rolling out a national competitive bidding project would require such a support system. He said the agency estimates the project would require adding anywhere from one to two dozen full-time employees.

"We do most of our work through contracts," Wynn said. "Even when you add those contractors to the number of additional CMS employees, it'd be a small fraction of what they're predicting."

Wynn said he's overseen the demonstrations in Polk County, Fla., and San Antonio by himself, with the help of one intern, who's now gone, and various assistants. He said the problem with the report is that it assumes CMS would put each of the 260 CAAs out to bid at the same time. He said the agency would phase-in the CAAs over the course of three years.

"That means we will only need one central bid staff, and we would work through the bids in a sequential manner, about two per week," Wynn wrote in a follow-up e-mail. "Thus, we would need a single staff to input, evaluate and contract for the bids."

Even so, Cuervo said rolling out a national competitive bidding project would add a layer of bureaucracy to an agency that already has too many. "It's not only about cost," she said. "CMS can barely manage Medicare today, and what this is going to do is create yet another layer of bureaucracy."

The report concludes that CMS should not roll out national competitive bidding until the following occur: the two demonstrations are completed; the administrative, financial and outcomes data are analyzed; additional demonstrations are conducted; and public comment is sought. HME