08/09/2012

Expert Debunks Claim that Bidding Doesn't Hurt Beneficiaries

According to the American Association for Homecare, Al Lewis, an expert in health management measurement who teaches health policy at Brandeis University, has sent a letter to Department of Health and Human Services Secretary Kathleen Sebelius and CMS Acting Administrator MarilynnTavenner stating that the CMS methodology for tracking health status in the competitive bid areas is inaccurate and invalid.

Currently, CMS uses only those beneficiaries with a claim in the previous 120 days for any given condition, such as diabetes, as the basis for their heath status evaluation. In an April 17 report CMS asserted that "there have been no negative effects on the health of people on Medicare or their access to needed supplies and services."

However, Lewis contends that the results are significantly skewed because the evaluation doesn't include beneficiaries who have not filed a recent claim. He states that there are at least nine reasons why those suffering from chronic diseases can't be identified through claims data, including non-compliance. "It is clear that a large number of beneficiaries with chronic disease are not being tracked in this analysis. Given that beneficiaries with chronic disease account for the majority of Medicare costs, it is critical for the entire population to be tracked in any health outcomes analysis."

To ensure that the health status evaluation is valid, Lewis recommends that CMS not "have a claims-based algorithm drive the identified patient pool but rather have the entire population be the pool."

Lewis is the author of the recently published book Why Nobody Believes the Numbers: Distinguishing Fact from Fiction in Population Health Management.