Form CMS-10197 AppendixC-NonstatisticalInstruments

Evaluation of Medicare National Competitive Bidding Program for DME

CMS-10197 AppendixC-NonstatisticalInstruments11_6_508ready

Non-Statistical Data - Private Sector (Focus Groups)

OMB: 0938-1015

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APPENDIX C:
Nonstatistical Data Collection Instruments

OMB# 0938-NEW

Focus Group Guide: Referral Agents (Wave 1)
Introduction (5 minutes)
Welcome. Thank you for joining us today. I am ___________ [Insert your name] from Abt
Associates Inc. We do research on health care. I will be moderating our discussion and _______
[Insert co-moderator] will be assisting and taking notes.
The topic we’ll be discussing today is the changes in Medicare with regard to durable medical
equipment and the fee schedule they use to pay suppliers of these products. This “competitive
bidding program” has recently been implemented in your are Each of you has been asked to
participate because you are a referral agent that works with Medicare beneficiaries. We are
particularly interested in your perspective on the current durable medical equipment market and
suppliers available to Medicare beneficiaries. Over the next year and a half, two more focus
groups will be held in your area as a part of this study. Focus groups are also being held in other
areas and these will help the Centers for Medicare & Medicaid Services (CMS) understand the
impact of the program.

Informed Consent (5 minutes)
•
•
•
•
•
•
•
•
•
•
•
•

•
•

Before we begin, I need to read aloud some of the key points of the consent form you
just signed. Did everyone sign the form?
Today we will ask you to discuss your experiences with Medicare beneficiaries and
durable medical equipment
Your participation is voluntary
The focus groups will last approximately 1.5 hours
The discussion will be confidential
You can refuse to take part in this focus group if you wish without affecting your
professional relationship with CMS
You do not have to answer any questions you do not wish to answer
You can quit the study at any time
We do not foresee any possible risks from participating in this focus group, other than
the minimal risk that confidentiality might not be preserved
There are no costs to you for participating in the focus group
You will receive $75 today for participating and dinner is provided
This discussion will not be video or audiotaped, rather ________ [Insert comoderator] will be taking notes. The notes from tonight will be labeled with a study
code, not your names, and they will be kept in a locked file and/or a passwordprotected computer at Abt Associates Inc. in Cambridge, Massachusetts. A summary
of the notes will be shared with CMS
Your comments, and those of others in the focus group, will be used in reports to the
government, in summary form and your name will not be included in the report
Does anyone have any questions?

Abt Associates Inc.

Focus Group Guide: Referral Agents (Wave 1)

How the focus group will work (3 minutes)
•
•
•
•
•
•
•
•

Want to keep the discussion informal and relaxed
Eat and use the restrooms as you like
During the discussion, please feel free to ask me or each other if something is unclear
There are no right or wrong answers
If you disagree with what someone else says, or have a different experience, please
say so or I’ll think that you all agree
Some of you may have strong opinions, so please be respectful of other’s
Be careful not to talk all at once; I don’t want to miss anything that is said
My job is to make sure we hear from everyone. Some people talk more than others,
and I’ll be encouraging everyone to speak up.

Participant Introductions (7 minutes)
Let’s go around the room and quickly introduce ourselves. [Write on the flip chart the following
items]
•
•
•
•
•

First name
Title (for example social worker, discharge planner, etc)
Organization you represent
Clients you serve
Role with durable medical equipment

BASELINE ENVIRONMENT
1.

Could you describe the referral process as it happens in your role? Let’s go around
the room.
- From beginning to end
- What do you do for your patients? (e.g. file the certificate of medical necessity –
CMN)
- How is it different as a discharge planner, Physical Therapist, social worker, home
health worker, etc?

How do you determine which supplier you refer your clients to?
a. Do you have a list of suppliers? Where does it come from?
b. Do you have a preferred supplier?
c. Are you satisfied with your interactions with suppliers? Why or why not?
d. Do you find any significant problems related to accessing suppliers at present?

Abt Associates Inc.

Focus Group Guide: Referral Agents (Wave 1)

How is the DMEPOS market in this area?
a. Are there enough suppliers?
b. Is there a dominant supplier?
i. For oxygen?
ii. Product X, Y, Z?
c. How do suppliers compete for referrals?
d. Do suppliers market their services?
i. How do they market? (pamphlets, visits, etc.)
ii. To whom do they market? (you, patients, etc.)

What do you think of the current level of access and quality of DMEPOS products
and services that suppliers provide your clients?

COMPETITIVE BIDDING PROGRAM
5.

How many of you have heard about Medicare’s change in the durable medical
equipment fee schedule for suppliers, also known as “competitive bidding”?

COUNT NUMBER OF RAISED HANDS _______
PROGRAM DESCRIPTION: The competitive bidding program for durable medical equipment,
prosthetic, orthotic supplies (DMEPOS) is a program administered by the Center for Medicare
and Medicaid Services (CMS), part of the Department of Health and Human Services (DHS), to
control the costs of DMEPOS by requiring suppliers to bid for a contract to provide DMEPOS
products and services to Medicare beneficiaries. This will result in a new fee schedule for
specific DMEPOS items, which could reduce the number of suppliers available to beneficiaries
and potentially change the suppliers with whom you work. Currently the suppliers are
submitting their bids and CMS is beginning to provide information to referral agents and
beneficiaries.
6.

How did you hear about the program?

What are your initial thoughts about it?

How do you think the program will affect your role?
-

Abt Associates Inc.

The referral process? (e.g. if suppliers you previously used are not
winning bidders)

Focus Group Guide: Referral Agents (Wave 1)

How do you think the program will affect suppliers in your area?
- Reduce the numbers?
- More marketing?
- Change in level of service provided?

10.

How do you think the program will affect Medicare beneficiaries?

QUALITY STANDARDS
11.

How many of you have heard about the “quality standards” required of DMEPOS
suppliers for items & services provided Medicare beneficiaries?

COUNT NUMBER OF RAISED HANDS _______
QUALITY STANDARDS DESCRIPTION: As a part of the Medicare Modernization Act 2003,
the Center for Medicare and Medicaid Services (CMS) requires Durable Medical Equipment,
Prosthetic, Orthotic Supplies (DMEPOS) Suppliers to comply with newly established quality
standards in order to receive payment for items or services provided to Medicare beneficiaries.
12.

What do you think of the quality standards?
a. Are they needed?
b. Is there a problem with them?
c. Will they change your role?
d. How will they affect beneficiaries?

ENDING QUESTION
13.

Do you have any final thoughts about the current state of DMEPOS in this area or
the competitive bidding program?

Those are all the questions that I have today. I want to thank you for participating in this
discussion.

Abt Associates Inc.

Focus Group Guide: Referral Agents (Wave 1)

OMB# 0938-NEW

Focus Group Guide: Referral Agents (Wave 3)
Introduction (5 minutes)
Welcome. Thank you for joining us today. I am ___________ [Insert your name] from Abt
Associates Inc. We do research on health care. I will be moderating our discussion and _______
[Insert co-moderator] will be assisting and taking notes.
The topic we’ll be discussing today is the changes in Medicare with regard to durable medical
equipment and the fee schedule they use to pay suppliers of these products. This “competitive
bidding program” has recently been implemented in your are Each of you has been asked to
participate because you are a referral agent that works with Medicare beneficiaries. We are
particularly interested in your perspective on the current durable medical equipment market and
suppliers available to Medicare beneficiaries. Over the next year and a half, two more focus
groups will be held in your area as a part of this study. Focus groups are also being held in other
areas and these will help the Centers for Medicare & Medicaid Services (CMS) understand the
impact of the program.

Informed Consent (5 minutes)
Before we begin, I need to read aloud some of the key points of the consent form you just signed.
Did everyone sign the form?
•
•
•
•
•
•
•
•
•
•
•

•
•

Today we will ask you to discuss your experiences with Medicare beneficiaries and
durable medical equipment
Your participation is voluntary
The focus groups will last approximately 1.5 hours
The discussion will be confidential
You can refuse to take part in this focus group if you wish without affecting your
professional relationship with CMS
You do not have to answer any questions you do not wish to answer
You can quit the study at any time
We do not foresee any possible risks from participating in this focus group, other than
the minimal risk that confidentiality might not be preserved
There are no costs to you for participating in the focus group
You will receive $75 today for participating and dinner is provided
This discussion will not be video or audiotaped, rather ________ [Insert comoderator] will be taking notes. The notes from tonight will be labeled with a study
code, not your names, and they will be kept in a locked file and/or a passwordprotected computer at Abt Associates Inc. in Cambridge, Massachusetts. A summary
of the notes will be shared with CMS
Your comments, and those of others in the focus group, will be used in reports to the
government, in summary form and your name will not be included in the report
Does anyone have any questions?

Abt Associates Inc.

Focus Group Guide: Referral Agents (Wave 3)

How the focus group will work (3 minutes)
•
•
•
•
•
•
•
•

Participant Introductions (7 minutes)
Let’s go around the room and quickly introduce ourselves. [Write on the flip chart the following
items]
•
•
•
•
•

First name
Title (for example social worker, discharge planner, etc)
Organization you represent
Clients you serve
Role with durable medical equipment

QUESTIONS
1.

We spoke with some of you a few months after the program began, in the midst of
transition. Now a year later does it seem that the transition is complete (for you,
suppliers, beneficiaries)?
-

Transitioning to new suppliers?

Other aspects?

What changes have you noticed since the program began a year ago?
a. Changes in the referral process
b. Suppliers
i. Quantity of suppliers?
ii. Quality of suppliers?
iii. How and to whom they market?
iv. Product changes?

Abt Associates Inc.

Focus Group Guide: Referral Agents (Wave 3)

How has the program affected your work and role?
-

Changes in the referral process

New relationships with suppliers

Extra or different responsibilities

Difficulties/Challenges

How has the competitive bidding program affected beneficiary care?
a. In terms of access
i. Are there adequate numbers of suppliers in the area?
-

For oxygen

For products X, Y, Z

ii. Convenience?
b. In terms of facility
i. Changes in products provided?
ii. Diverse array of products?
iii. Quality of services provided?
c. Have patients been able to get information when they have problems or questions?
5.

What changes have you noticed in the DMEPOS market?
a. Are there enough suppliers?
b. Is there a new dominant supplier?
i. For oxygen?
ii. Product X, Y, Z?
c. How do suppliers compete for referrals?
d. Do suppliers market their services?
i. How do they market? (pamphlets, visits, etc.)
ii. To whom do they market? (you, patients, etc.)

Abt Associates Inc.

Focus Group Guide: Referral Agents (Wave 3)

This program included a requirement that suppliers meet certain quality standards,
have you noticed any changes?

IF PARTICIPANTS AREN’T FAMILIAR WITH THE STANDARDS, READ DESCRIPTION
BELOW
QUALITY STANDARDS DESCRIPTION: As a part of the Medicare Modernization Act 2003,
the Center for Medicare and Medicaid Services (CMS) requires Durable Medical Equipment,
Prosthetic, Orthotic Supplies (DMEPOS) Suppliers to comply with newly established quality
standards in order to receive payment for items or services provided to Medicare beneficiaries.
7.

What do you think of the quality standards?
a. Are they needed?
b. Is there a problem with them?
c. Will they change your role?
d. How will they affect beneficiaries?

What do you see as the successes and failures of the program?
-

Poorer suppliers have left the market

What questions or concerns about the program do you have as it continues
forward?

10.

Do you have any final thoughts about the Medicare competitive bidding program?

Those are all the questions that I have today. I want to thank you for participating in this
interview.

Abt Associates Inc.

Focus Group Guide: Referral Agents (Wave 3)

OMB# 0938-NEW

Focus Group Guide: Suppliers (Wave 1)
Introduction (5 minutes)
Welcome. Thank you for joining us today. I am ___________ [Insert your name] from Abt
Associates Inc. We do research on health care. I will be moderating our discussion and _______
[Insert co-moderator] will be assisting and taking notes.
The topic we’ll be discussing today is the changes in Medicare durable medical equipment,
prosthetic, orthotic, supplies (DMEPOS) fee schedule for suppliers. Your area has been chosen
as a site for implementation. Each of you has been asked to participate because you are a
supplier or supplier group representative that provides DMEPOS products and services to
Medicare beneficiaries. We are particularly interested in your experiences and perspectives on
this new program. Over the next year and a half, two more focus groups will be held in your
area as a part of this study. Focus groups are also being held in other areas and these will help
the Centers for Medicare & Medicaid Services (CMS) understand the impact of the program.

Informed Consent (5 minutes)
Before we begin, I need to read aloud some of the key points of the consent form you just signed.
Did everyone sign the form?
•
•
•
•
•
•
•
•
•
•
•

•
•

Today we will ask you to discuss your experiences with preparing for this new fee
schedule and providing DMEPOS to Medicare beneficiaries
Your participation is voluntary
The focus groups will last approximately 1.5 hours
The discussion will be confidential
You can refuse to take part in this focus group if you wish without affecting your
professional relationship with CMS
You do not have to answer any questions you do not wish to answer
You can quit the study at any time
We do not foresee any possible risks from participating in this focus group, other than
the minimal risk that confidentiality might not be preserved
There are no costs to you for participating in the focus group
You will receive $75 today for participating and dinner is provided
This discussion will not be video or audiotaped, rather ________ [Insert comoderator] will be taking notes. The notes from tonight will be labeled with a study
code, not your names, and they will be kept in a locked file and/or a passwordprotected computer at Abt Associates Inc. in Cambridge, Massachusetts. A summary
of the notes will be shared with CMS
Your comments, and those of others in the focus group, will be used in reports to the
government, in summary form and your name will not be included in the report
Does anyone have any questions?

Abt Associates Inc.

Focus Group Guide: Suppliers (Wave 1)

How the focus group will work (3 minutes)
•
•
•
•
•
•
•
•

Participant Introductions (7 minutes)
Let’s go around the room and quickly introduce ourselves. [Write on the flip chart the following
items]
•
•
•

First name
Supplier or organization you represent
Types of DMEPOS you provide

BASELINE ENVIRONMENT
1.

How do Medicare beneficiaries get to each of you as a supplier?
a. Discharged from hospital? Referred from clinics? Walk-ins?
b. Who refers them to you?
c. Are you satisfied with your referral patterns?

Do you think that there are an adequate number of suppliers in this area? Why or
why not?

COUNT # OF RAISED HANDS
3.

How many of you think beneficiaries are generally satisfied with their choices of
DMEPOS suppliers in this area? Why?

COUNT # OF RAISED HANDS

BIDDING PROGRAM
4.

How many of you are aware of the Medicare DMEPOS competitive bidding
program?

COUNT # OF RAISED HANDS

Abt Associates Inc.

Focus Group Guide: Suppliers (Wave 1)

a. When did you first hear about it?
b. How did you hear about the program?
-

Informational meeting by CMS?

Trade organization?

When you first heard about the competitive bidding program, what did you think?

Do you think your area (MSA) is a good market for competitive bidding? Why or
why not?

One goal of competitive bidding is to reduce the prices that Medicare pays for
DMEPOS. Medicare has included products Z,Y,Z in the competitive bidding
program: X, Y, and Z.
a. Which of these product groups has the greatest potential of obtaining lower prices
from competitive bidding?
-

b. Which has the least potential?
c. Are there any excluded product groups that should be in the program?
8.

What did you hear from CMS about the program and Requests for Bids (RFBs)?
a. Were you officially notified?
b. What materials did you receive?
c. What did you think of the materials?
-

Were they clear?

Straightforward?

Complete?

d. Do you feel that you were adequately informed?
e. Was a Medicare representative available for questions? Who was it? Were they
helpful?

Abt Associates Inc.

Focus Group Guide: Suppliers (Wave 1)

How many of you submitted the bid?

COUNT # OF RAISED HANDS
a. Why did you decide to bid?
b. How did you decide which products to bid on? Why?
10.

11.

What do you think of the bidding process?
-

Does it seem appropriate?

Is it too much?

Confusing?

How is it compared to private bids you have made?

Did it take long time to complete the bidding process? How long?

CMS (or bidding program manager) available?

Do you have a good sense of how they are going to evaluate the bids and pick the
winners?

PROGRAM IMPACT
12.

How do you anticipate the program will affect you as a supplier?
a. If you lose a bid(s), how will it affect you? Why?
b. If you win a bid(s), how will it affect you? Why?

13.

How do you think the program will impact Medicare beneficiaries?

14.

How might the program affect the quality of DMEPOS supplies and services you
are able to provide? Can you give me an example?

15.

What do you think of the DMEPOS quality standards?

16.

What challenges/issues do you anticipate arising with this program?

ENDING QUESTION
17.

Do you have any final thoughts about the Medicare competitive bidding program as
it gets underway?

Those are all the questions that I have today. I want to thank you for participating in this
interview.

Abt Associates Inc.

Focus Group Guide: Suppliers (Wave 1)

OMB# 0938-NEW

Focus Group Guide: Suppliers (Wave 3)
Introduction (5 minutes)
Welcome. Thank you for joining us today. I am ___________ [Insert your name] from Abt
Associates Inc. We do research on health care. I will be moderating our discussion and _______
[Insert co-moderator] will be assisting and taking notes.
The topic we’ll be discussing today is the changes in Medicare durable medical equipment,
prosthetic, orthotic, supplies (DMEPOS) fee schedule for suppliers. Your area has been chosen
as a site for implementation. Each of you has been asked to participate because you are a
supplier or supplier group representative that provides DMEPOS products and services to
Medicare beneficiaries. We are particularly interested in your experiences and perspectives on
this new program. Over the next year and a half, two more focus groups will be held in your
area as a part of this study. Focus groups are also being held in other areas and these will help
the Centers for Medicare & Medicaid Services (CMS) understand the impact of the program.

Informed Consent (5 minutes)
Before we begin, I need to read aloud some of the key points of the consent form you just signed.
Did everyone sign the form?
•
•
•
•
•
•
•
•
•
•
•

•
•

Abt Associates Inc.

Focus Group Guide: Suppliers (Wave 3)

How the focus group will work (3 minutes)
•
•
•
•
•
•
•
•

Participant Introductions (7 minutes)
Let’s go around the room and quickly introduce ourselves. [Write on the flip chart the following
items]
•
•
•

First name
Supplier or organization you represent
Types of DMEPOS you provide

PROGRAM IMPACT
1.

It has been a year since the Medicare competitive bidding program began.
a. What has been successful about the program?
b. What has been unsuccessful?

How has the program affected you as a supplier?

Can you provide examples of “tough” choices you have had to make as a result of
the program?
-

Have you had to cut back on staff/employees?

Have you decreased the frequency of f/u visits?

How has the competitive bidding program affected the products and services you
are able to provide?

How has the program affected beneficiaries?

Do you have any final comments about the Medicare competitive bidding
program?

Abt Associates Inc.

Focus Group Guide: Suppliers (Wave 3)

Has your relationship with CMS or the DMEPOS changed in anyway because of the
competitive bidding? How?

Those are all the questions that I have today. I want to thank you for participating in this
interview.

Abt Associates Inc.

Focus Group Guide: Suppliers (Wave 3)

Key Informant Discussion Guide: Beneficiary Groups/Advocates
(WAVE 1)
1.

What is the name of your organization?

What type of organization are you? What role do you serve?
a. Are you a local/national organization?
b. Does your local organization use resources, activities, etc. designed or distributed by
a parent organization?
c. Is your organization part of a community level coalition? Working with other
organizations? Please describe.
d. Who are your clients/constituents?
e. Are any of your clients Medicare beneficiaries? What percent?

Do you work with Medicare beneficiaries? With DMEPOS?
a. What do you do for Medicare beneficiaries regarding DMEPOS? Please provide
examples?
i. Educational services?
ii. Outreach?
iii. Advocacy?
iv. Lobbying?
v. Referral?
vi. Financial Assistance?

How is the DMEPOS supplier market in this area currently structured?
a. Are the available suppliers spread out or are they concentrated in a particular
geographic area?
b. Is there a dominant supplier?
c. Are there both large and small suppliers?
d. Do you perceive that there are an adequate number of suppliers in this area? IF NOT,
for what products is supply inadequate?
e. Do suppliers have to compete? Based on what?

Abt Associates Inc.

Key Informant Discussion Guide: Beneficiary Groups/Advocates (Wave 1

Quality?

Price?

Service?

Referral agents?

f. How do suppliers market their products and services?
g. Do the suppliers compete with mail-order suppliers?
5.

Do you refer beneficiaries to suppliers?
a. Which ones?
b. How do you decide which suppliers to refer people to? Do you have a list?
c. How did you develop the referral list?

What do you think of the current level of DMEPOS products and services provided
Medicare beneficiaries? Please provide examples.
a. Access?
b. Quality?
c. Diversity of products? Choice?
d. Ancillary services – education, maintenance, et

Have you heard of the Medicare plan to use Competitive Bidding to modify the
DMEPOS fee schedule for reimbursing suppliers?

INTERVIEWER: If they have not heard of the program, read the description below.
PROGRAM DESCRIPTION: The competitive bidding program for durable medical equipment,
prosthetic, orthotic supplies (DMEPOS) is a program administered by the Center for Medicare
and Medicaid Services (CMS), part of the Department of Health and Human Services (DHS), to
control the costs of DMEPOS by requiring suppliers to bid for a contract to provide DMEPOS
products and services to Medicare beneficiaries. This will result in a new fee schedule for
specific DMEPOS items and could reduce the number of suppliers available to beneficiaries.
Currently the suppliers are submitting their bids and CMS is beginning to provide information to
referral agents and beneficiaries.
a. What do you think about it?
b. How do you think it might affect (positively and negatively) your clients?

Abt Associates Inc.

Key Informant Discussion Guide: Beneficiary Groups/Advocates (Wave 1

Does your organization have a policy or position statement on Medicare’s
competitive bidding program?

Do you have any final comments about the current environment of DMEPOS for
Medicare beneficiaries in your area (and the competitive bidding program)?

Abt Associates Inc.

Key Informant Discussion Guide: Beneficiary Groups/Advocates (Wave 1

Key Informant Discussion Guide: Beneficiary Groups/Advocates
(WAVE 2)
1.

What information has your organization received regarding the DMEPOS
Competitive Bidding Program?
a. What did you receive?
b. When?
c. From whom?
d. Did you find the information helpful?
e. What questions are remaining for you?
f. What additional information would have been helpful?

What, if anything, has your organization been doing with regard to Medicare
beneficiaries, DMEPOS and this relatively new program?
-

Educational activities

Outreach

Have members/clients asked about the program?
a. What types of questions or comments are you getting?
b. What are the primary concerns or issues being raised?

Have any suppliers contacted you regarding the program?
a. What was the purpose of the contact?
b. What was your response?

Did CMS conduct any outreach efforts to educate beneficiaries about the program
through your organization? Describe.

How do you think DMEPOS suppliers have changed over the past few months
(under the competitive bidding program)?
a. Number of suppliers? Is it adequate?
b. Has there been a change in suppliers? (Those not part of the program)
c. Has there been a change in how suppliers compete? Based on what?

Abt Associates Inc.

Key Informant Discussion Guide: Beneficiary Groups/Advocates (Wave 2)

Quality?

Price?

Service?

Referral agents?

d. Suppliers marketing their products and services?
7.

Have you noticed any impact of the program on beneficiaries?
a. Access to DMEPOS?
b. Quality of DMEPOS?
c. Diversity of products? Choice?
d. Ancillary services – education, maintenance, et

Do you think the program will ultimately be successful? Why or why not?”

Do you have any final comments about the relatively new competitive bidding
program for Medicare beneficiaries and DMEPOS?

Abt Associates Inc.

Key Informant Discussion Guide: Beneficiary Groups/Advocates (Wave 2)

Key Informant Discussion Guide: Beneficiary Groups/Advocates
(WAVE 3)
1.

It has been a year since the inception of the competitive bidding program. What do
think of the program at this point?
a. Successes of the program
b. Failures or limitations
c. Significant changes

What has your organization done with or for beneficiaries with regard to DMEPOS
over the past year related to the program? (e.g. education)
a. How does that differ from your activities prior to the program?

How has the program affected you as an organization in any way, or your role?

How do you think the DMEPOS suppliers available to beneficiaries have changed
over the past year (under the competitive bidding program)?
a. Number of suppliers? Is it adequate?
b. Competition among suppliers?
-

Quality?

Price?

Service?

Referral agents’ preferences?

c. The way that suppliers market?
5.

From what you have seen and heard, how has the program affected beneficiaries?
a. Access to DMEPOS?
b. Quality of DMEPOS?
c. Diversity of products? Choice?
d. Ancillary services – training, maintenance, et
e. Assistance with insurance?

Abt Associates Inc.

Key Informant Discussion Guide: Beneficiary Groups/Advocates (Wave 3)

Do you have any final comments about the competitive bidding program for
Medicare beneficiaries and their DMEPOS? Suggestions to make the program
better?

Abt Associates Inc.

Key Informant Discussion Guide: Beneficiary Groups/Advocates (Wave 3)

Key Informant Discussion Guide: CMS Officials or CMS’ Bidding
Program Managers (Wave 1)
Researcher Note: Some questions may be more appropriate for the CMS official than for the
bidding program manager and vice versa. Inform the participant at the beginning that they can
defer if he/she is not the appropriate individual to answer that question.
1.

Responsibility for Program Administration
a. What are the responsibilities of CMS officials versus the bidding program managers?
b. How will the competitive bidding program be administered in this MSA?
c. Who is responsible for administration?
d. What responsibilities reside at the local level?
e. How is oversight of local program administration to be carried out?
f. When will (was) the program be initiated at this site?

Process for Selecting Suppliers (Ask questions only if it is unknown from available

materials)?
a. How were suppliers and the potential bidders informed about the program?
i. bidders conferences/meetings?
ii. written materials?
iii. other means of education
b. How was the RFB distributed?
c. What information was required of bidders in the RFB?
-

quality (customer service, facilities, inventory, etc)

service capacity

finances

geographic coverage

d. What support was provided to suppliers in constructing their bids?
e. How are suppliers being selected?
3.

How do you anticipate this program will affect the referral process?

Abt Associates Inc. Key Informant Discussion Guide: CMS Officials or CMS’ Bidding Program Managers (Wave 1)

a. For referral agents?
b. Suppliers?
c. Beneficiaries?
d. Beneficiary advocates
4.

Program Outreach and Dissemination
a. How and when will referral agents be notified that the program has begun?
b. How and when will beneficiaries be notified?
c. What vehicles of communication will be used for outreach?
d. When were (will) materials sent out? What was sent? (can we get copies)

Assessment of the Market
a. What process will be used to assess overall supplier capacity in the market?
b. How will the ability of suppliers to increase capacity be assessed?
c. How will geographic coverage in the market be assessed?
d. Are any changes projected in the physician authorization process expected as part of
the program? If so, what are they?
e. Is an exemption process for small suppliers anticipated? If so, what are the key
features of this process likely to be?

Plans for Program Monitoring
a. What type of complaint reporting system is envisioned for the program? How will it
differ from the system now in place?
b. What ombudsman services will be available for consumers?
c. What data will the ombudsman collect? Are the data available?
d. How will the program be monitored locally?
e. What rules are likely to be implemented or steps taken to create a level playing field
for small suppliers?
f. What

General Observations

Abt Associates Inc. Key Informant Discussion Guide: CMS Officials or CMS’ Bidding Program Managers (Wave 1)

a. What do you see as the biggest obstacles to program implementation in this MSA?
Why?
b. What are your biggest concerns about your ability to monitor supplier performance?
c. How long do you think it will be before some form of steady state under the program
will be achieved?
d. Overall, in your opinion. What is the biggest threat to the success of the program in
this MSA?

Abt Associates Inc. Key Informant Discussion Guide: CMS Officials or CMS’ Bidding Program Managers (Wave 1)

Key Informant Discussion Guide: CMS Officials or CMS’ Bidding
Program Managers (Wave 2)
Researcher Note: Some questions may be more appropriate for the CMS official than for the
bidding program manager and vice versa. Inform the participant at the beginning that they can
defer if he/she is not the appropriate individual to answer that question.
1.

Program Administration
a. How has the administration of the program gone?
b. What has been successful? Unsuccessful?
c. After the program was begun, what were the most important issues that arose
requiring decisions or policy refinement? How were they resolved?

Selecting Suppliers
a. How and when were the RFBs distributed?
b. What support was provided to suppliers in constructing their bids?
c. How did the selection process go? What problems arose?
d. How were winners selected?
e. How were winners informed about the program?

Supplier market
a. Are there enough suppliers?
b. Have the suppliers been able to maintain the capacity they proposed?
c. Are suppliers meeting the needs of beneficiaries?

How has the program affected the referral process?
a. For referral agents?
b. Suppliers?
c. Beneficiaries?

Program Outreach and Dissemination
a. Was the program outreach successful? Unsuccessful?
b. How and when were referral agents and beneficiaries notified about the program?

Abt Associates Inc. Key Informant Discussion Guide: CMS Officials or CMS’ Bidding Program Managers (Wave 2)

c. What vehicles of communication were used for outreach?
d. When were materials sent out? What was sent?
6.

Program Monitoring
a. How is the program monitored?
b. Is there a complaint reporting system?
i. What types of complaints have you received?
c. How is quality being monitored or assessed as the program rolls out?

What have been the reactions to the program from each of these stakeholders?
a. Suppliers
b. Referral agents
c. Beneficiaries
d. Beneficiary advocacy organizations
e. Congress

General Observations
a. What do you think were the biggest obstacles? Why? Can they be corrected?
b. What are your biggest concerns as the program moves forward?
c. What areas to you see as needing improvement and can they be addressed within the
coming ½ year?
d. What changes, if any, do you anticipate for the remainder of this initial year of the
program?

Abt Associates Inc. Key Informant Discussion Guide: CMS Officials or CMS’ Bidding Program Managers (Wave 2)

Key Informant Discussion Guide: CMS Officials or CMS’ Bidding
Program Managers (Wave 3)
Researcher Note: Some questions may be more appropriate for the CMS official than for the
bidding program manager and vice versa. Inform the participant at the beginning that they can
defer if he/she is not the appropriate individual to answer that question.
1.

Supplier market
a. Are there enough suppliers?
b. Have the suppliers been able to maintain the capacity they proposed?
c. Are suppliers meeting the needs of beneficiaries? How is that being determined?

How has the program affected the referral process?
a. For referral agents?
b. Suppliers?
c. Beneficiaries?

Program Outreach and Dissemination
a. Was the program outreach successful? Unsuccessful?
b. How and when were referral agents and beneficiaries notified?
c. What vehicles of communication were used for outreach?
d. Were they effective?
e. When were materials sent out? What was sent?
f. How has the ongoing communication gone compared to the initial communication?

Program Monitoring
a. How is the program monitored?

Abt Associates Inc. Key Informant Discussion Guide: CMS Officials or CMS’ Bidding Program Managers (Wave 3)

b. Is there a complaint reporting system?
i. What types of complaints have you received?
ii. What are the most common complaints?
iii. What is the process for resolving – for example?
c. How is quality being monitored or assessed as the program is being implemented?
6.

What has been the impact of the program on each of these stakeholders?
a. Suppliers
b. Referral agents
c. Beneficiaries
d. Beneficiary advocacy organizations

General Observations
a. Did the problems or concerns with the program in the first months improve over the
subsequent 9 months?
b. What do you think were the biggest obstacles? Why? Can they be corrected?
c. What have been the big problems with the program?
d. What areas do you see as needing improvement?
e. What changes do you think would better meet the goals of this competitive bidding
program?

Abt Associates Inc. Key Informant Discussion Guide: CMS Officials or CMS’ Bidding Program Managers (Wave 3)

Key Informant Discussion Guide: Referral Agents (Wave 1)
Background Information
1.

What is your title and training?

What organization are you affiliated with and what type of an organization is it?

What is your role in working with clients generally and Medicare beneficiaries
specifically?

Which DMEPOS products do your clients most frequently use?

Referral Process
5.

Could you describe your referral process from beginning to end?
a. How or when do you get involved with patients/clients?
-

Discharged from hospital?

Referral from doctor’s office?

b. What do you do for patients?
-

File the certificate of medical necessity (CMN)?

c. Do you feel satisfied with the outcomes you can achieve? Why or why not?
6.

How is the DMEPOS market in this area?
a. Are there enough suppliers?
b. Is there a dominant supplier?
i. For oxygen?
ii. Product X, Y, Z?

Abt Associates Inc.

Key Informant Discussion Guide: Referral Agents (Wave 1)

c. How do suppliers compete for referrals?
d. Do suppliers market their services?
i. How do they market? (pamphlets, visits, etc.)
ii. To whom do they market? (you, patients, etc.)
8.

What do you think of the current level of access and quality of DMEPOS products
and services that suppliers provide your clients?

BIDDING PROGRAM
PROGRAM DESCRIPTION: The competitive bidding program for durable medical equipment,
prosthetic, orthotic supplies (DMEPOS) is a program administered by the Center for Medicare
and Medicaid Services (CMS), part of the Department of Health and Human Services (DHS), to
control the costs of DMEPOS by requiring suppliers to bid for a contract to provide DMEPOS
products and services to Medicare beneficiaries. This will result in a new fee schedule for
specific DMEPOS items, which could reduce the number of suppliers available to beneficiaries
and potentially change the suppliers with whom you work. Currently the suppliers are submitting
their bids and CMS is beginning to provide information to referral agents and beneficiaries.
9.

Have you heard about Medicare’s change in the durable medical equipment fee
schedule for suppliers, also known as “competitive bidding”?

10.

How did you hear about it?

11.

What are your initial thoughts about it?

12.

How do you think competitive bidding will affect your role?
-

Referral process

To whom you refer patients

Suppliers you prefer or do not prefer

13.

How do you think the program will affect suppliers in your area?

14.

How do you think competitive bidding could affect Medicare beneficiaries?
-

Access to products

Quality of services

QUALITY STANDARDS
15.

Have you heard about the “quality standards” required of DMEPOS suppliers for
items & services provided Medicare beneficiaries?

Abt Associates Inc.

Key Informant Discussion Guide: Referral Agents (Wave 1)

What do you think of the quality standards?
a. Are they needed?
b. Is there a problem with them?
c. Will they change your role?
d. How will they affect beneficiaries?

Closing Question
17.

Do you have any final thoughts about the current state of DMEPOS and the new
Medicare competitive bidding program?

Abt Associates Inc.

Key Informant Discussion Guide: Referral Agents (Wave 1)

Key Informant Discussion Guide: Referral Agents (Wave 2)
Skip questions 1 to 4 if the referral agent was a participant in Wave 1.
1.

Background Information

What is your title and training?

What organization are you affiliated with and what type of an organization is it?

What is your role in working with clients generally and Medicare beneficiaries
specifically?

Which DMEPOS products do your clients most frequently use?

The DMEPOS competitive bidding program began a few months ago. How was the
information you were provided regarding the program?
a. General information about the program
i. From whom?
ii. What form?
b. List (directory) of “winning” suppliers?
i. Received in a timely manner?
ii. From whom?
iii. In what form? (email, paper, etc.)
c. Information regarding what (which supplies) is covered
d. Information received
i. Did you find it helpful? Why or why not?
ii. Has CMS or its representatives been available to respond to concerns?”
iii. From whom else did you receive information?
iv. What other information would you like?

The Medicare competitive bidding program has been underway the past few
months. How has the transition been?
a. Have you had to transition to new suppliers? For what services?

Abt Associates Inc.

Key Informant Discussion Guide: Referral Agents (Wave 2)

b. Have there been any significant issues relating to suppliers that did not exist prior to
this program?
i. How did they arise?
ii. Why do you believe they are related to the new program?
8.

What changes have you noticed in your role/work since the program began?
a. Referral process?
b. Your professional relationships? (e.g. with suppliers)
c. Difficulties?

What changes have you noticed in the quality and access of DMEPOS products
provided Medicare beneficiaries?
a. Are there an adequate number of suppliers?
i. For oxygen?
ii. For product X, Y, Z?
b. Have the specific products provided changed? (e.g. brand of a product)
c. How has the quality of services provided changed? (e.g. instruction provided, followup visits, timeliness, etc.)

10.

What changes have you noticed in the DMEPOS supplier market, with regard to the
following?
a. Number of suppliers available?
b. Dominance of certain suppliers?
i. For oxygen?
ii. Product X, Y, Z?
c. How suppliers compete for referrals?
d. How suppliers market their services?
i. How they market? (pamphlets, visits, etc.)
ii. To whom they market? (you, patients, etc.)

11.

What do beneficiaries know about this program?

Abt Associates Inc.

Key Informant Discussion Guide: Referral Agents (Wave 2)

12.

Are they aware of the program?

Have they noticed changes? What?

What questions, if any, have your clients/patients been asking with regard
to this program?

Have they been able to get help when they have problems or questions?

What could be done to better inform beneficiaries?

The change in Medicare DMEPOS included a requirement that suppliers meet
certain quality standards. Are you familiar with these standards?

IF THE INFORMANT ISN’T FAMILIAR WITH THE STANDARDS, READ DESCRIPTION
BELOW, THEN ASK QUESTION 8.
QUALITY STANDARDS DESCRIPTION: As a part of the Medicare Modernization Act 2003,
the Center for Medicare and Medicaid Services (CMS) requires Durable Medical Equipment,
Prosthetic, Orthotic Supplies (DMEPOS) Suppliers to comply with newly established quality
standards in order to receive payment for items or services provided to Medicare beneficiaries.
13.

What do you think of the quality standards?
a. Are they needed?
b. Is there a problem with them?
c. Have they changed your role at all?
d. Have they affected the products and services provided beneficiaries?

14.

What questions or concerns about the program do you have as it continues
forward?

15.

Do you have any final thoughts about the Medicare competitive bidding program?

Abt Associates Inc.

Key Informant Discussion Guide: Referral Agents (Wave 2)

Key Informant Discussion Guide: Referral Agents (Wave 3)
Skip questions 1 to 4 if the referral agent was a participant in Wave 1.

Background Information
1.

What is your title and training?

What organization are you affiliated with and what type of an organization is it?

What is your role in working with clients generally and Medicare beneficiaries
specifically?

Which DMEPOS products do your clients most frequently use?

We spoke a few months after the program began, still in the midst of transition.
Now a year later, what changes have you noticed since the program began?

Has your work or role changed since the program was implemented?

New challenges?

Extra or different responsibilities?

Relationships

What changes have you noticed in the DMEPOS supplier market?
a. Changes in the referral process?
b. Suppliers
i. Adequate number of suppliers?
ii. Quality of suppliers available to beneficiaries?
iii. Product changes?

How has the competitive bidding program affected beneficiary care?
a. Access to DMEPOS products and services?
b. Diverse array of products?
c. Quality or level of products and services provided?
d. Have patients been able to get information when they have problems or questions?
e. How and to whom suppliers market?

Abt Associates Inc.

Key Informant Discussion Guide: Referral Agents (Wave 3)

f. Timeliness of DMEPOS product provision and services?
g. Communication with suppliers?
9.

What do you see as the successes and failures of the program?
-

Poorer suppliers have left the market

Supplier response to service requests is not as quick

10.

What questions or concerns about the program do you have as it continues
forward?

11.

Do you have any suggestions for how it could be improved?

12.

Do you have any final thoughts about the Medicare competitive bidding program?

Abt Associates Inc.

Key Informant Discussion Guide: Referral Agents (Wave 3)

Key Informant Discussion Guide: Suppliers (Wave 1)
1.

What DMEPOS do you provide?
-

Oxygen

Wheelchairs

Hospital beds

Orthotics

Prosthetics

Are you accredited? By whom?

How would you describe yourself as a supplier?
a. How long have you been supplying DMEPOS?

Large vs. small

Niche vs. full service

Geographic limitations

How do Medicare beneficiaries get to you as a supplier?
a. Discharged from hospital? Referred from clinic? Walk-in? Most common? Variation
by service type?
b. Who refers them to you?

Are you satisfied with your referral network at present?
a. How do referral agents know about your services?
b. How do you market your products and services?
c. What types of referrals do you get?
d. How are your relationships with referral agents?

What services are beneficiaries typically provided as a part of the DMEPOS? (If
you provide a lot of DMEPOS, describe the services provided with one of your
highest volume products?)
a. Delivery and set-up

Abt Associates Inc.

Key Informant Discussion Guide: Suppliers (Wave 1)

i. Who does it? What is their background or training?
b. Equipment maintenance
c. Level of training or instruction provided
d. Type and frequency of follow-up

DMEPOS Market
7.

How would you describe the DMEPOS supplier market in this area?
-

Are suppliers spread out or concentrated in a particular geographic here?

Is there a dominant company? If so, How does this vary, if at all, by
product type?

Do you perceive that there are an adequate number of suppliers? If so,
How does this vary by product type?

Where do you fit as a supplier in this market?
a. How do you compete with other suppliers?
-

Price

Service / Quality

Referral agents’ preferences

b. To what extent do you compete with mail-order suppliers?

Competitive Bidding
9.

What have you heard from CMS (or CMS’ bidding program managers) about the
competitive bidding program and Request for Bids (RFBs)?
a. Were you officially notified?
b. What materials did you receive?
c. What did you think of the materials?
-

Were they clear?

Straightforward?

Complete?

Abt Associates Inc.

Key Informant Discussion Guide: Suppliers (Wave 1)

d. Do you feel that you were adequately informed?
e. Was a Medicare representative available for questions? Who was it? Were they
helpful?
10.

Did you submit a bid(s)?
a. Why did you decide to bid?
b. How did you choose products you bid on?

11.

What did you think of the bidding process?
a. Do you have a good understanding of how bids will be evaluated and chosen?
b. Do you feel that adequate consideration has been given to ensuring that small
suppliers can participate in the program (are you a small/large supplier)?

Program Impact
12.

If you win, how will it affect your company?
a. What will you gain?
b. Will you supply fewer (more) brands of products?
c. How you market your products and services?

13.

If you lose, how will it affect your company?
a. What will you gain/lose?
b. Will you supply fewer (more) brands of products?
c. How you market your products and services?

14.

How do you anticipate the program will affect Medicare beneficiaries?
a. Will beneficiaries be able to get the same products and services they had before this
program?
b. Will suppliers experience any pressure to shift to lower-quality products? If so, how
will that happen (e.g. lower profit margins)?
c. What other influences will affect the products and services used by patients you work
with?

15.

What do you think will be the changes both positive and negative on quality?

Abt Associates Inc.

Key Informant Discussion Guide: Suppliers (Wave 1)

Consulting with prescribers

Assessing appropriateness of the equipment

Develop service plan

Equipment management? Repairs? Adjustments?

Replacing equipment

16.

Procedure for equipment delivery and set-up? Who sets up? Their
Background?
Provide training or instruction? Who does this?
What information or training is provided? Operation? Safety? Repair?
Written or oral?
Follow-up

Any other thoughts about the program or its likely impact?

Abt Associates Inc.

Key Informant Discussion Guide: Suppliers (Wave 1)

Key Informant Discussion Guide: Suppliers (Wave 2)
Skip questions 1 to 6 if supplier participated in wave 1.
1.

What DMEPOS do you provide?
-

Oxygen

Wheelchairs

Hospital beds

Orthotics

Prosthetics

Are you accredited? By whom?

How would you describe yourself as a supplier?
a. How long have you been supplying DMEPOS?

Large vs. small

Niche vs. full service

Geographic limitations

How do Medicare beneficiaries get to you as a supplier?
a. Discharged from hospital? Referred from clinic? Walk-in? Most common? Variation
by service type?
b. Who refers them to you?

What services are beneficiaries typically provided as a part of the DMEPOS?
-

Abt Associates Inc.

If you provide a lot of DMEPOS, describe the services provided with one
of your highest volume products?

Key Informant Discussion Guide: Suppliers (Wave 2)

a. Delivery and set-up
i. Who does it? What is their background or training?
b. Equipment maintenance
c. Level of training or instruction provided
d. Type and frequency of follow-up

The Bidding Process
7.

Overall, how was the bidding process?
-

Did you have the resources you needed to submit a bid?

Was the receipt of the information timely?

Was the process described in the information you received?

Did you have outside assistance formulating your bid(s)?

Have you had experience formulating bids for the private sector and was the
process similar? In what respect was it different?

10.

How was the notification process?

11.

Timeliness

Fairness

Did you win any of the bid(s) you submitted? Lose any of the bid(s)?

INTERVIEWER: If the supplier lost a bid asks questions 6-8,17,then stop. If they won a bid skip
to question 9. If they won & lost a bid ask all questions.

Losing Bids
12.

Were you informed in a timely manner that you lost the bid(s)?

13.

Do you think the decision was fair, in light of what you know about other suppliers’
bids?
-

14.

What do you believe were the most important factors in losing the bid?

What effect will losing have on your business?
-

Abt Associates Inc.

Relationships with referral agents?

Key Informant Discussion Guide: Suppliers (Wave 2)

Relationships with equipment distributors/suppliers?

Changes in personnel or staffing?

Effect on other aspects of your work?

Convert part of the store?

Merge? Sell?

Write your congressman?

Winning Bids
15.

Were you informed in a timely manner that you won the bid(s)?

16.

Do you feel that the bid decisions were fair? Why or why not?

17.

What effect do you think winning is having and will continue to have on your
business?
-

Relationships with referral agents?

Personnel or staffing?

Finances

Billing system

Number of clients

Products and services provided

Transition

18.

Do you think enough suppliers won contracts in this area to provide for the
Medicare beneficiaries? Why or why not?

19.

How has the transition to this new contractual relationship with CMS gone?

20.

Has CMS or its representatives been available to respond to concerns or issues?”

21.

What effect, if any, has the provision in place for beneficiaries to transition to
different suppliers had?

The Program Impact
22.

With changes in reimbursement have you had to make tough choices about the
provision of DMEPOS product and services? If yes, what were they?

Abt Associates Inc.

Key Informant Discussion Guide: Suppliers (Wave 2)

a. What factors were important in reaching these decisions?
23.

24.

How have beneficiaries been affected by this program?
-

Access to products

Level of services provided

What do you think of the quality standards required with the program?
-

Burdensome / Helpful?

Applicable / Appropriate?

Suggestion for how they could be improved?

25.

What concerns do you anticipate will arise as the program roles out over the next
year?

26.

Is there anything else that you would like to tell us about the program?

Abt Associates Inc.

Key Informant Discussion Guide: Suppliers (Wave 2)

Key Informant Discussion Guide: Suppliers (Wave 3)
Skip questions 1 to 6 if supplier participated in wave 1.

BACKGROUND INFORMATION:
1.

What DMEPOS do you provide?
-

Oxygen

Wheelchairs

Hospital beds

Orthotics

Prosthetics

Are you accredited? By whom?

How would you describe yourself as a supplier?
a. How long have you been supplying DMEPOS?

Large vs. small

Niche vs. full service

Geographic limitations

How do Medicare beneficiaries get to you as a supplier?
a. Discharged from hospital? Referred from clinic? Walk-in? Most common? Variation
by service type?
b. Who refers them to you?

What services are beneficiaries typically provided as a part of the DMEPOS?

Abt Associates Inc.

Key Informant Discussion Guide: Suppliers (Wave 3)

If you provide a lot of DMEPOS, describe the services provided with one
of your highest volume products?

a. Delivery and set-up
i. Who does it? What is their background or training?
b. Equipment maintenance
c. Level of training or instruction provided
d. Type and frequency of follow-up

PROGRAM IMPACT
7.

How has the competitive bidding program changed your business?
a. Number of clients
b. Products and services provided
c. Personnel / staffing
d. Financially / Billing system
i. Prices for non-Medicare clients
ii. Private pay clients
e. Marketing

Since the institution of the competitive bidding program (~12 months ago) what
have you had to change (and why) in terms of the following:
a. Products provided
b. Delivery and set-up
i. Who does it? Their background or training?
c. Equipment maintenance
d. Level of training or instruction provided
e. Frequency of follow-ups

Overall, what have been the consequent changes in your provision of DMEPOS and
the associated services under this program?

Abt Associates Inc.

Key Informant Discussion Guide: Suppliers (Wave 3)

10.

How do you think the competitive bidding program has changed the DMEPOS
supplier market in this area?
-

11.

In terms of concentration in a given geographic area?

Is there a change in the dominant company? If so, Does it vary, if at all,
by product type?

Are there an adequate number of suppliers? If so, Does this vary by
product type?

Has the competitive bidding program changed your location in the supplier market?
a. Where you fit in this market?
b. How you compete with other suppliers?
-

Price

Service / Quality

Referral agents’ preferences

c. Competition with mail-order suppliers?
12.

How do you think the program has been successful? Why?

13.

What do you think have been the failures or limitations of the program? Why?

14.

How has the competitive bidding affected the provision of DMEPOS for Medicare
beneficiaries? (From the referral process all the way to the arrival of the product in
the beneficiaries home)

15.

Lastly, what feedback do you have for CMS to improve the program for your area
and the new areas that will begin competitive bidding?

Abt Associates Inc.

Key Informant Discussion Guide: Suppliers (Wave 3)

Key Informant Discussion Guide: COMPARISON AREA: Beneficiary
Groups/Advocates (WAVE 1)
1.

What is the name of your organization?

What type of organization are you? What role do you serve?
a. Are you a local/national organization?
b. Does your organization use resources, activities etc. from a parent organization?
c. Is your organization part of a coalition? Working with other organizations? Please
describe.
d. Who are your clients/constituents?

Do you work with Medicare beneficiaries? With DMEPOS?
a. What do you do for Medicare beneficiaries with regard to DMEPOS? Please provide
examples?
i. Educational services?
ii. Outreach?
iii. Advocacy?
iv. Lobbying?
v. Referral?
vi. Financial Assistance?

How is the DMEPOS supplier market in this area currently?
a. Are suppliers spread out or are they concentrated in a geographic area?
b. Is there a dominant supplier?
c. Are there both large and small suppliers?
d. Do you perceive that there are an adequate number of suppliers in this area?
e. Do suppliers have to compete? Based on what?
-

Quality?

Price?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Beneficiary Groups/Advocates (Wave 1)

Service?

Referral agents’ preferences?

f. How do suppliers market their products and services?
g. Do the suppliers compete with mail-order suppliers?
5.

Do you refer beneficiaries to suppliers?
a. Which ones?
b. How do you decide which suppliers to refer clients to? Do you have a list?
c. From where do you get your referral list? (or how do you create it)?

What do you think of the current level of DMEPOS products and services provided
Medicare beneficiaries? Please provide examples.
a. Access to DMEPOS?
b. Quality of DMEPOS?
c. Diversity of products? Choice?
d. Ancillary services – education, maintenance, et

Do you have any additional comments or information that might be helpful if I am
trying to understand the DMEPOS market in this area?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Beneficiary Groups/Advocates (Wave 1)

Key Informant Discussion Guide: COMPARISON AREA: Beneficiary
Groups/Advocates (WAVE 2)
1.

Since we last spoke (X months ago) have there been any changes in the DMEPOS
products and services in this area? And why?
-

Number of suppliers?

Quality of products and services?

Since we last spoke have there been any changes in your role working with
Medicare beneficiaries and their DMEPOS ?

What, if anything, has your organization been doing differently (the past few
months) with regard to Medicare beneficiaries and DMEPOS ?
-

New education programs

Have your clients raised any new questions or concerns over the past months? If so,
what were they?

Have you heard of or are you familiar with the new Quality Standards for
DMEPOS put out by the Centers for Medicare and Medicaid Services (CMS)?

QUALITY STANDARDS DESCRIPTION: As a part of the Medicare Modernization Act 2003,
the Center for Medicare and Medicaid Services (CMS) requires Durable Medical Equipment,
Prosthetic, Orthotic Supplies (DMEPOS) Suppliers to comply with newly established quality
standards in order to receive payment for items or services provided to Medicare beneficiaries.
a. What information have you received about them?
-

From whom?

When?

b. Have they changed your role?
c. Are beneficiaries aware of them?
d. How do you think the standards will affect beneficiaries?
e. What have you heard from suppliers about them?
f. What do you think about them?
i. Positives?
ii. Negatives?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Beneficiary Groups/Advocates (Wave 2)

Have there been any changes in the DMEPOS supplier market the past few months?
a. Number of suppliers? Is it adequate?
b. Competition among suppliers? Based on what?
-

Quality? Price? Service? Referral agents?

c. Suppliers marketing their products and services?
7.

Are you aware of any occurrences in health care or this area that have impacted
DMEPOS products, services, provision, etc.?
-

Product recall

New type of equipment

Health care crisis – (e.g. higher incidence of pneumonia)

New regulations or policies (e.g. Deficit Reduction Act cap on rentals)

Has the level of care beneficiaries are provided for DMEPOS changed over the past
few months?
a. Access to DMEPOS?
b. Quality of DMEPOS?
c. Diversity of products? Choice?
d. Ancillary services – education, maintenance, et

Do you have any additional comments about new occurrences in your area with
regard to Medicare beneficiaries, DMEPOS and suppliers?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Beneficiary Groups/Advocates (Wave 2)

Key Informant Discussion Guide: COMPARISON AREA: Beneficiary
Groups/Advocates (WAVE 3)
1.

Since we last spoke (X months ago) have there been any changes in the DMEPOS
products and services in this area? Why?
-

Number of suppliers?

Quality of products and services?

Since we last spoke have there been any changes in your role working with
Medicare beneficiaries and their DMEPOS?

What, if anything, has your organization been doing differently (the past year) with
regard to Medicare beneficiaries and DMEPOS? (e.g. education).

Have your clients raised any new questions or concerns over the past year? If so,
what were they?

What has changed with regard to the Quality Standards for DMEPOS?
a. Have they changed your role?
b. Are beneficiaries aware of them?
c. How do you think the standards are impacting beneficiaries’ care?
d. What have you heard from suppliers about the standards?
e. What do you think about them, a year since they were required?
i. Positives?
ii. Negatives?

How do you think the DMEPOS supplier market has changed over the past year?
a. Number of suppliers? Is it adequate?
b. Competition among suppliers? Based on what?
-

Quality? Price? Service? Referral agents?

c. Suppliers marketing their products and services?
7.

Are you aware of any occurrences in health care or this area that have impacted
DMEPOS products, services, provision, etc.?
-

Abt Associates Inc.

Product recall

Key Informant Discussion Guide: Comparison Area: Beneficiary Groups/Advocates (Wave 3)

New type of equipment

Health care crisis – (e.g. higher incidence of pneumonia)

New regulations or policies (e.g. Deficit Reduction Act cap on rentals)

Has the level of care beneficiaries are provided for DMEPOS changed over the past
year?
a. Access to DMEPOS?
b. Quality of DMEPOS?
c. Diversity of products? Choice?
d. Ancillary services – education, maintenance, et

Do you have any additional comments about new occurrences in your area with
regard to Medicare beneficiaries, DMEPOS and suppliers?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Beneficiary Groups/Advocates (Wave 3)

Key Informant Discussion Guide: COMPARISON AREA: Referral
Agents (Wave 1)
Role
1.

What is your title and training?

What organization are you affiliated with and what type of an organization is it?

What is your role in working with clients generally and Medicare beneficiaries
specifically?

What DMEPOS products do your clients use?

Referral Process
5.

Could you describe the referral process from beginning to end?
a. How or when do you get involved with patients/clients?
-

Discharged from hospital?

Referral from doctor’s office?

b. What do you do for patients?
6.

CMN – do you fill out?

Regarding the suppliers you refer beneficiaries to, how do you decide to whom you
refer your patients?
-

Do you have a list of suppliers?

Where did you get the list or how did you create that list?

How competitive is the DMEPOS market in this area?
-

Enough suppliers? A lot of options?

A dominant supplier?

What do you think of the current level of care provided beneficiaries in this area?
a. Quality of DMEPOS?
b. Access to DMEPOS?
c. Diversity of products?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Referral Agents (Wave 1)

d. Ancillary services?

Quality Standards
9.

Have you heard of or received information about the new Quality Standards for
DMEPOS put out by the Centers for Medicare and Medicaid Services (CMS)?

What do you think of the Quality Standards generally?
a. What is good about them?
b. What is a problem with them?
c. Are they appropriate/fair?
d. Will they change your business/role?
e. How will they affect beneficiaries?

11.

What do you think of the specific aspects of the Quality Standards, are they
appropriate, inappropriate, excessive, etc.?
a. Consulting with prescribers
b. Assessing appropriateness of the equipment
c. Develop service plan
d. Equipment management? Repairs? Adjustments?
e. Replacing equipment
f. Procedure for equipment delivery and set-up? Who sets up? Their background?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Referral Agents (Wave 1)

g. Provide training or instruction? Who does this?
h. What information or training is provided? Operation? Safety? Repair? Written or
oral?
i. Follow-up

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Referral Agents (Wave 1)

Key Informant Discussion Guide: COMPARISON AREA: Referral
Agents (Wave 2)
1.

Since we last spoke (X months ago), have there been any changes in the referral
process for you?
-

Which supplier you refer clients to?

Changes in paperwork needed/requested by suppliers?

How do you think the DMEPOS supplier market has changed over the past few
months?
a. Number of suppliers? Is it adequate?
b. Competition among suppliers? Based on what?
-

Quality? Price? Service? Referral agents?

c. Suppliers marketing their products and services?
3.

Have there been any changes in the level of care provided beneficiaries?
a. Access to DMEPOS?
b. Quality of DMEPOS?
c. Diversity of products? Choice?
d. Ancillary services – training, maintenance, et

Have your clients/patients raised any new questions or concerns over the past
months? If so, what were they?

Have there been any occurrences in health care or this area that have impacted
DMEPOS products, services, provision, etc.?

Product recall

New type of equipment

Health care crisis – (e.g. higher incidence of pneumonia)

New regulations or policies (e.g. Deficit Reduction Act cap on rentals)

How have the DMEPOS Quality Standards affected you?
a. Have they changed your role?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Referral Agents (Wave 2)

b. Are beneficiaries aware of the standards?
c. How are the standards affecting beneficiaries?
d. What do you think about them now, a few months later?
i. Positives?
ii. Negatives?
7.

Do you have any additional comments about new occurrences in your area with
regard to Medicare beneficiaries, DMEPOS and suppliers?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Referral Agents (Wave 2)

Key Informant Discussion Guide: COMPARISON AREA: Referral
Agents (Wave 3)
1.

Since we last spoke (X months ago), have there been any changes in the referral
process for you?
-

Which supplier you refer clients to?

Changes in paperwork needed/requested by suppliers?

How do you think the DMEPOS supplier market has changed over the past year?
a. Number of suppliers? Is it adequate?
b. Competition among suppliers? Based on what?
-

Quality? Price? Service? Referral agents?

c. Suppliers marketing their products and services?
3.

Have your clients/patients raised any new questions or concerns over the past
months? If so, what were they?

Have there been any occurrences in health care or this area that have impacted
DMEPOS products, services, provision, etc.?

Product recall

New type of equipment

Health care crisis – (e.g. higher incidence of pneumonia)

New regulations or policies (e.g. Deficit Reduction Act cap on rentals)

How have the DMEPOS Quality Standards affected you?
a. Have they changed your role?
b. Are beneficiaries aware of the standards?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Referral Agents (Wave 3)

c. How are the standards affecting beneficiaries?
d. What do you think about them now, a few months later?
i. Positives?
ii. Negatives?
7.

Do you have any additional comments about new occurrences in your area with
regard to Medicare beneficiaries, DMEPOS and suppliers?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Referral Agents (Wave 3)

Key Informant Discussion Guide: COMPARISON AREA: Suppliers
(Wave 1)
Baseline Environment
1.

What DMEPOS do you provide?
-

Oxygen

Wheelchairs

Hospital beds

Orthotics

Prosthetics

Are you accredited? By whom?

How would you describe yourself as a supplier?
a. How long have you been supplying DMEPOS?

Large vs. small

Niche vs. full service

Geographic limitations

How do beneficiaries get to you as a supplier?
a. Discharged from hospital? Referred from clinic? Walk-in?
b. Who refers them to you?
c. How do referral agents know about your services?

Do you market your products and services?

What is your relationship with referral agents?

Are you satisfied with your referral patterns?
a. How do referral agents know about your services?
b. How do you market your products and services?
c. What types of referrals do you get?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Suppliers (Wave 1)

d. How are your relationships with referral agents?
6.

What services are beneficiaries typically provided as a part of the DMEPOS?
a. Delivery and set-up
i. Who does it? Their background or training?
b. Equipment maintenance
i. Who does it? Their background or training?
c. Frequency of follow-ups
i. Who does it? Their background or training?

Market
7.

How would you describe the DMEPOS supplier market in this area?
-

Are suppliers spread out or concentrated in a particular geographic area?

Is there a dominant company?

Do you perceive that there are an adequate number of suppliers?

How do you view yourself as a supplier?
a. Where do you fit in this market?
b. How do you compete with other suppliers?
-

Price

Service / Quality

Referral agents’ preferences

To what extent do you compete with mail-order suppliers?
Quality Standards
9.

Have you heard of or received information about the new Quality Standards for
DMEPOS put out by the Centers for Medicare and Medicaid Services (CMS)?
a. What information have you received about them?
i. From whom?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Suppliers (Wave 1)

ii. When?
b. Has CMS or its representatives been available to respond to concerns?
c. Has your professional organization informed you about it?
10.

11.

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Suppliers (Wave 1)

Key Informant Discussion Guide: COMPARISON AREA: Suppliers
(Wave 2)
Skip questions 1 to 6 if supplier participated in wave 1.
1.

What DMEPOS do you provide?
-

Oxygen

Wheelchairs

Hospital beds

Orthotics

Prosthetics

Are you accredited? By whom?

How would you describe yourself as a supplier?
a. How long have you been supplying DMEPOS?

Large vs. small

Niche vs. full service

Geographic limitations

How do beneficiaries get to you as a supplier?
a. Discharged from hospital? Referred from clinic? Walk-in?
b. Who refers them to you?
c. How do referral agents know about your services?

Do you market your products and services?

What is your relationship with referral agents?

Are you satisfied with your referral patterns?
a. How do referral agents know about your services?
b. How do you market your products and services?
c. What types of referrals do you get?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Suppliers (Wave 2)

d. How are your relationships with referral agents?
6.

What services are beneficiaries typically provided as a part of the DMEPOS?
a. Delivery and set-up
i. Who does it? Their background or training?
b. Equipment maintenance
c. Level of training or instruction provided
d. Frequency of follow-ups

Since we last spoke a few months ago, have there been any changes in the referral
process (how beneficiaries get to you as a supplier)?
a. Discharged from hospital? Referred from clinic? Walk-in?
b. Who refers them to you?
c. How do referral agents know about your services?
-

Do you market your products and services?

What is your relationship with referral agents?

Are you currently satisfied with your referral patterns?

Have you changed any of the DMEPOS products and services you provide
beneficiaries? For what reason?

10.

Delivery and set-up. If so, Who does it? Their background or training?

Equipment maintenance

Level of education or instruction provided

Frequency of follow-ups

Product makes and models offered?

Have there been any significant changes in the DMEPOS supplier market in this
area over the past few months? What? Why?
-

11.

Change in the suppliers in the area

Have there been any occurrences in health care or this area that have impacted
DMEPOS products, services, provision, etc.?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Suppliers (Wave 2)

12.

Product recall

New type of equipment

Health care crisis – (e.g. higher incidence of pneumonia)

New regulations or policies (e.g. Deficit Reduction Act cap on rentals)

How have the DMEPOS Quality Standards affected you?
a. Affected your business?

13.

Have they changed your role?
a. Are beneficiaries aware of the standards?
b. How are the standards affecting beneficiaries?
c. What do you think about them now, a few months later?
i. Positives?
ii. Negatives?

14.

Do you have any additional comments about new occurrences in your area with
regard to Medicare beneficiaries, DMEPOS and suppliers?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Suppliers (Wave 2)

Key Informant Discussion Guide: COMPARISON GROUP: Suppliers
(Wave 3)
Skip questions 1 to 6 if supplier participated in wave 1.
1.

What DMEPOS do you provide?
-

Oxygen

Wheelchairs

Hospital beds

Orthotics

Prosthetics

Are you accredited? By whom?

How would you describe yourself as a supplier?
a. How long have you been supplying DMEPOS?

Large vs. small

Niche vs. full service

Geographic limitations

How do beneficiaries get to you as a supplier?
a. Discharged from hospital? Referred from clinic? Walk-in?
b. Who refers them to you?
c. How do referral agents know about your services?

Do you market your products and services?

What is your relationship with referral agents?

Are you satisfied with your referral patterns?
a. How do referral agents know about your services?
b. How do you market your products and services?
c. What types of referrals do you get?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Suppliers (Wave 3)

d. How are your relationships with referral agents?
6.

Since we last spoke, have there been any changes in the referral process (how
beneficiaries get to you as a supplier)?
a. Discharged from hospital? Referred from clinic? Walk-in?
b. Who refers them to you?
c. How do referral agents know about your services?
-

Do you market your products and services?

What is your relationship with referral agents?

Are you currently satisfied with your referral patterns?

Have you changed any of the DMEPOS products and services you provide
beneficiaries? For what reason?

10.

Delivery and set-up. If so, Who does it? Their background or training?

Equipment maintenance

Level of education or instruction provided

Frequency of follow-ups

Product makes and models offered?

Have there been any significant changes in the DMEPOS supplier market in this
area over the past few months? What? Why?
-

11.

Change in the suppliers in the area

Have there been any occurrences in health care or this area that have impacted
DMEPOS products, services, provision, etc.?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Suppliers (Wave 3)

12.

Product recall

New type of equipment

Health care crisis – (e.g. higher incidence of pneumonia)

New regulations or policies (e.g. Deficit Reduction Act cap on rentals

Now that the DMEPOS quality standards have been in place a year what do you
think?
a. How have they affected your business?
b. Have they changed your role?
c. Are beneficiaries aware of the standards?
d. How are the standards affecting beneficiaries?
e. What do you think about them now, a few months later?
i. Positives?
ii. Negatives?

13.

Do you have any additional comments about new occurrences in your area with
regard to Medicare beneficiaries, DMEPOS and suppliers?

Abt Associates Inc.

Key Informant Discussion Guide: Comparison Area: Suppliers (Wave 3)

File Type	application/pdf
File Title	APPENDIX C:
Author	NicholsonJ
File Modified	2009-11-06
File Created	2009-11-05