PAOC Is Big Forum

The Centers for Medicare and Medicaid Services held its first meeting of the Program Advisory and Oversight Committee (PAOC) on Oct. 6 to provide advice as CMS implements the competitive bidding provisions mandated by last year's Medicare Prescription Drug, Improvement and Modernization Act (MMA). As a member of that panel, I believe we have an enormous responsibility to provide CMS with constructive inputs to this process.

This is not the forum to register our collective and fierce opposition to competitive bidding. Rather, Congress is the appropriate audience for that message since it was Congress that wrote the law. Until Congress repeals or changes the competitive bidding provisions, CMS has no choice but to move forward and work on its implementation plan.

While it is too early to assess whether CMS will incorporate the counsel of the PAOC into its implementation plans — and panel members expressed differing views on multiple issues, making that task far more difficult — the process provides a forum not just for PAOC members but also for the larger industry to give input.

During the meeting, the panel heard presentations from CMS and its contractor, Research Triangle Institute (RTI), about various issues related to the two competitive bidding demonstrations and implementation of the competitive bidding program that will begin in 2007. RTI presented a summary of its evaluation report of the Polk County, Fla., and San Antonio, Texas, demonstrations that were conducted between 1999 and 2002.

RTI also presented the committee with a series of questions related to structuring the competitive bidding program. For example, should CMS use one or more of the DMERCs or another entity to administer the various functions — such as bid evaluation, quality and access monitoring, and evaluation — of a competitive bidding program?

CMS plans to gain input from the PAOC on the development of quality standards, also mandated in last year's MMA. The panel heard a presentation from RTI, whose representatives had already met with a number of the major accreditation organizations. On these issues, CMS was receptive to input regarding these questions: