Limited meeting agenda
While those questions and others--such as why CMS' estimates were so high and why so few providers bid--were the issues committee members wanted to discuss, Bachenheimer said, the PAOC session lasted just one day and focused mainly on technical bidding problems in Round One and updates on Round Two, when bidding will expand to 70 more metro areas across the U.S.

"Maybe that's why a number of members didn't show," Bachenheimer said, noting that the committee was given the agenda only a week ahead of time. Five of the PAOC's 21 members were absent from the meeting.

Bachenheimer also voiced strong concerns with CMS' lack of transparency regarding competitive bidding. "We've made repeated requests for substantive answers" to problems but can't get them, Bachenheimer said. Even though competitive bidding will determine the fate of thousands of providers, she added, "the whole process has so many unknowns ... There should be an open dialogue on something that's so crucial" to so many.

"The meeting was pretty much what I expected: CMS saying, 'We had software problems, they were fixed or will be fixed before the next round,'" said attendee Mike Hamilton of Association Services, Hoover, Ala., director of the Alabama Durable Medical Equipment Association.

But Kuhn told HomeCare Monday the meeting was set for one day because that's what many PAOC members wanted, noting "they're all busy, too." As for the agenda, he said, policy issues surrounding competitive bidding had largely been dealt with, and CMS' main task now is focusing on its implementation in Round Two.

Regarding any "unintended consequences" of competitive bidding, such as possible hits on beneficiary access, Kuhn said, "that's what the PAOC is about. If there are problems, we'll address them. The key is to make sure beneficiaries are served appropriately."

In other information given at the meeting, officials said CMS plans to pick the first-round winners in December but will not announce them until March or April of 2008. The gap is intended to give the winners time to decide whether they want to sign contracts; if not, additional suppliers will have to be chosen.

The agency said it would also unveil "very soon" the next 70 CBAs in which the bidding project will be rolled out. Bidding for Round Two will begin next year, and reimbursement based on that round is expected to start in 2009.

In addition, officials announced steps intended to smooth the bidding process in the second round, including:

--Simplification of the registration process while keeping the bidding system secure.
--An "intensive" campaign to educate suppliers on National Supplier Clearinghouse requirements to make sure they're correct and don't snag bidders during registration.
--Implementing controls to keep multiple users from accessing the system with the same user ID.
--Preparing "a comprehensive and user-friendly guide" to the bidding process.
--Home page status indicators with hotlinks to incomplete information and pointers to incomplete bid data.
--Letting bidders copy and paste identical bid data from one bid sheet to another, rather than having to re-enter it.
--Changing the verbiage in error messages to provide "clear and user-friendly language, free of technical jargon."

Some PAOC members, as well as some public commenters, urged CMS to take these additional steps:

--Reveal the actual financial ratios used to determine the financial viability of bidders. So far, the agency has refused to do so, citing fear that some would use the data to gain an unfair advantage.
--Announce the date by which all Medicare suppliers must be accredited. This is a key step that some PAOC members said would prompt suppliers outside current bidding areas to get accredited as soon as possible.
--Drop complex rehab as a bidding category. "Of all power mobility device users, at least 60 percent, and perhaps 80 percent, have requested customizing from manufacturers or others to configure systems that meet individual needs," said PAOC member Jean Minkel, rehab services consultant for Independence Care System, New York. "I don't see the bid process meeting these needs for people who are already functionally limited."
--Create some kind of bid appeals mechanism, which Congress didn't authorize when it wrote the bidding law. The rejection of a bid "is a death sentence without any ability to appeal," said committee member Michael Tootell of MGFT Decisions.