TAHCS: Why?

In a great example of illiteracy, TAHCS has sent out a recent email to people in the industry. It begins with this in the subject line: "NEWS FORM TAHCS 07-03-2012." FORM? You guys can't even get your message subject right. How is anyone supposed to trust you to get bigger things right? 

TAHCS wants you to know that they're giving you important "... News from Texas to Washing D.C. ..." Where the hell is Washing D.C.? 

So it seems that after months of wonderful silence, the stooges have decided to start yammering again. It's been a nice break and I am sorry it's over.

In this recent release we are told that Barry Johnson is now the Executive Director of that group. Is that a step up from Sean Schwinghammer (or whatever his name is)? No. The skill set has not improved, and the replacement is very likely far less qualified to do the job (not that I have a high regard for Sean so please don't read into this what definitely isn't here because I still think he did the job as terribly as Joan Cross does for FAMES but she is a topic for a later blog that is way past due and I think it's right to tackle only one failure at a time). 

But what else can anyone expect from the guys of TAHCS? It is common knowledge in the industry that they have very few members and are pretty much broke. For those who would consider joining TAHCS: A fool and his money are soon parted, right? What have they done for you lately? Nothing. And that is what they will always do.

These guys annoy me. No legitimate and useful organization in the industry wants anything to do with them. No legitimate and useful organization in the industry takes them seriously (I'm looking at you AAHomecare and at you VGM for very good reasons, but largely because you've publicly supported the TAHCS buffoons). 

Now it has been a long time since I have blogged, and I normally insert pertinent quotes into what I write. But there are only so many quotes about stupidity, and I have to use them sparingly if these TAHCS buffoons are going to try to stick around. 

Here is what Barry Johnson calls news:

1. "CMS has submitted a request to have RAC Auditors to perform prepayment revews. This request will adversely effect every provider and cost DME providers thousands of dollars in unnecessary paperwork. The request may exceed the congressional authority of CMS."

The first two sentences are obvious and we didn't need Johnson to tell us that. But where do you suppose they got the idea that CMS has congressional authority? Oh, wait. The TAHCS Johnson thinks that CMS may have exceeded the authority that Congress granted to the agency. On what facts does the TAHCS Johnson base that statement? Oh, wait. That gang is notorious for getting things wrong and making things up, so they don't need facts.

2. "ACA has been upheld by the Supreme Court and this ruling signals no positive changes for DME providers." 

DUH. We could never have figured that out without the TAHCS Johnson.

"In the strange set of circumstances, Justice Roberts was known to change his mind (at the last minute) in favor of the ACA. Conservitative justices were unable to return his opinion back and thus the 5-4 ruling in favor of the mandate."

A strange set of circumstances? No. He sold us all out to the Obama administration who no doubt applied political pressure to make Roberts turn his coat. He is said to have changed his mind at the last minute.

"This ruling by the court will surely polarize [C]ongress and make any legislation to change Competitive Bidding dif[f]icult." 

Barry, Congress has no intention of changing competitive bidding. The village idiot can figure that one out. Why is that lost on you and how did you escape your village? And is it that hard for you to make the effort to spell correctly?

3. "GAO is known to be skeptical of auditors and is concerned about the financial and the necessary effectiveness of this process. They are requesting detailed audit information and said to be reviewing it for changes. It seems that auditing just for the sake of auditing, when their is no fraud intended or committed, is not the the intent nor is it good use of taxpayers dollars."

The GAO can give its opinion all it wants to. If Congress included audits, like RACs, in Obamacare, then the GAO is basically screwed. 

4. "According to the IRS, the Medical Tax Exemption has not been extended to all DME equipment and supplies. The IRS is willing to discuss the application of the exemptions, but refuses to make futher comments at this time.  DME providers can look forward to paying more for equipment and supplies until this matter is resolved."

And we can count on you heroes at TAHCS to resolve the matter, right? I didn't think so. You yahoos formed because you were going to accomplish what you alleged others were not doing. As near as I can tell you've accomplished less than the others. Garbage in, garbage out.

5. "The 5 Year replacement rule issued by the Medical Directors has been found to have no specific guidelines for the process.There are no identified HCPCS codes, therefore DME providers are essentially in the dark with the five year replacement process. DME providers may need to take their complaints to CMS."

Then again, DME providers may not need to. A meteor may hit the earth, too. But thanks for giving so much information and firm guidance, TAHCS.

 6. "HHSC is changing in Texas, and as of July 1, 2012, requiring all beneficiaries over 21 and recieve [I before E except after C] SSI to be enrolled in a Star Plan if available in their area. If providers service beneficiaries in an area served by Star Plans and are not a provider of these plans, providers cannot contiune [continue] to service these beneficiaries. The only exception is if the beneficiary is on recieving [I before E except after C] Medicare. TAHCS recommends providers check every beneficiary and their eligiability [eligibility] before providing further medical equipment and supplies."

There's so much wrong with this that I can't begin to tackle it, and I'm not talking solely about the horrific spelling. Because SCOTUS struck down the mandate to states about Medicaid, it is unclear what any state agency is going to do. But before I'd take any advice from TAHCS, I'd contact MESA to get the facts.

And then we get this:

Barry Johnson, has been named by TAHCS President Kevin Hill to fulfill the position of Executive Director. Johnson is the immediate Past President of TAHCS and also serves as the Legislative Director.  Johnson is expected to continue his position as Legislative Director while serving asTAHCS Executive Director. He is a founding member of TAHCS and serves an at large member of the Board of Directors.

Wasn't Johnson supposed to be the president of AMEPA? Can these incestuous little organizations not find any new blood? TACHS, do the industry a favor and disband but failing that (because you are not smart enough to stay away) please keep your Johnson to yourselves. He should not be allowed out in public and is as qualified to represent and work for the industry as Rob Brant (who is such a failure that he lost his business, which of course makes him qualified to tell the rest of you how to run your businesses). 

TAHCS goes on to say that "It[']s time for membership renewal for many TAHCS providers."

When did two or three become many?

TAHCS calls itself "your proactive association," yet the group has been dead silent for months (except now, when they want money). How can anyone call that approach proactive? Are they serious? Kevin Hill and Barry Johnson need to stop deluding themselves. They are still, along with Rob Brant, an industry joke. TACHS is an embarrassment. 

Where was TAHCS when its own Vice President, the ever-boastful industry-savior wannabe known as Dean Cheney, had to close his doors because of competitive bidding? Weren't Brant and his cronies supposed to succeed where all others had failed and make that go away?

PROactive? You guys can't even REact effectively. 

Join your organization? Give you money? Not on your lives. I don't fund ineffective windbags. You say "united we stand?" When is that, when you need money to bankroll your ineffectiveness? No thanks. I'll support the legitimate organizations that don't disappear for months at a time and who actually get things done.

StC Epic Fails of 2011

It's been a while since I've blogged.

I didn't have anything new to say and one person alone can't make a large group see sense.

AAHomecare is still a do-nothing association that has little to offer other than self-serving hot air. Our voice in Washington may as well be silenced because it surely has done no good and accomplished absolutely nothing in many years.

NAIMES is still touting that idiotic auction as a solution to our competitive bidding problem. Yes, Wayne Stanfield and company, let's trade one evil for another because that will surely save the industry. That's the dumbest strategy I've ever heard of, and I can't believe that anyone would pay to be a member of an organization that would back such a stupid idea.

Between the two, there isn't one good organization.

The Blind Leading the Blind
Don't worry, I'm not ignoring AMEPA. It was announced some time ago that Rob Brant was stepping down as President and that Barry Johnson was going to take his place. This is not an improvement because I think each man is equally ridiculous.

The AMEPA site still lists Brant as President, and as late as mid-August, Brant was still posting. These guys can't get it together enough to keep their site current.

Brant was "leading" meetings in Texas in August to discuss round two competitive bidding, and he was clearly impressed with the fact that he "committed" two weeks to the "project."

Really? Nothing says "success" like attending meetings "led" by a man who has a failed DME, who was rejected in the first round of round one and who barely managed to snag a single inadequate contract in the reboot, and who fell so spectacularly flat at ridding the industry of bidding. Brant formed AMEPA because he was convinced that he had all the answers. This man scheduled meetings and presumed to tell others how to prepare for bidding and how to engage legislators?

How many of you were gullible enough or desperate enough to fall for his self-proclaimed expertise?

If you want or need guidance, turn to the people who know what they're talking about, not the failures of the industry. I am always amazed and alarmed when I hear that someone has hired a "consultant" who was the owner of a DME that was a failure. Is it a case then of applying the mantra of "do as I say, not as I did?"

I doubt those AMEPA sessions were well-attended, so I'm going to do those who did fall prey to desperation a favor and offer some advice their own common sense should have told them to begin with: Never take advice from someone who wasn't competent to keep his own doors open.

If your consultant wasn't capable in his (or her) own venture, then he (or she) isn't capable in yours.

I Told You So
When the rocket scientists of TAHCS, combined with the equally smart Dean Cheney, came up with the been-there-done-that idea of filing suit to force CMS and HHS to detail the financial standards used in the bidding process, I said here on my blog that this was not going to work.

I was right. Again.

It was entertaining to watch Cheney doing his best imitation of a strutting rooster at industry events after the suit was filed, presenting himself as the underdog brave enough to fight CMS in court. It was amusing to watch Cheney all but beg for attention and praise for putting himself and his company out there; Cheney was a man willing to "take one for the team," and he wanted to make sure all of us knew it.

He had no investment in the case; it's not as though he was funding it. He was merely a front. But that didn't stop Cheney from trying to take as much of the credit and attention that he could grab. He put me in mind of all of the people these days who are famous for doing nothing. Kim Kardashian, anyone?

Anyone paying attention this week saw in HME News that the suit was dismissed because it basically lacked merit. The discretion granted to the Secretary in statute was very clear. Anti-bidding lawsuits don't get results for the industry. The lawyers involved may find it profitable, but in the end, there is no benefit to the DMEs.

Desperate times sometimes call for desperate measures, but how many times can the industry be defeated in court until it realizes that court is not the answer?

So What Is the Answer?
The answer is simple, really.

CMS can't have competitive bidding if the industry refuses to participate in the farce.

This approach requires that we all agree to refuse; this approach requires that each and every company in the round-two areas (even the nationals!) not submit a bid of any kind.

It requires solidarity. And that's why nothing has yet to or will ever work. There's always going to be a few who will have a winner-take-all mentality and submit stupidly low bids in an attempt to secure as many contracts as he (or she) can get. Knowing this, the rest of you will submit bids so you're not left out, and this is why round two and any future rounds will ultimately succeed.

The success of competitive bidding is guaranteed by the very industry so desperate to get rid of it. This ensures the most spectacular epic fail of all.

Winners and Losers and Fools (Oh My!)

I haven't had much to say lately because there hasn't been that much going on, and I can only talk about competitive bidding just so much before even I become bored repeating myself.

This morning I had two emails forwarded to me, and I read an article in HME News (print edition, May 2011). I've got something to say about each one.

Winners

The first email sent to me was one from MESA, telling its members that the Texas Comptroller of Public Accounts (TCPA) had announced that it was not going to go through with the competitive bid on incontinence products.

Here, minus the text from the TCPA, is what MESA sent out:

"MESA is very pleased to announce that the procurement initiative, developed and driven by the Texas Comptroller of Public Accounts (TCPA), with the assistance of Texas Health and Human Services Commission (HHSC), has been deemed unnecessary, and is no longer looming over Texas incontinence suppliers.

Persuading the TCPA that the initiative was not in the best interests of the agency or beneficiaries was a team effort, and MESA deeply appreciates the participation of all who helped shape its policy, and all who helped to deflect this initiative.

It is our further understanding that this decision means that this item will be withdrawn from the agenda of the MCAC meeting of June 9. So, it will not be necessary for providers to attend that meeting if their purpose in going was to testify about this particular matter. 

Moving forward from this point, MESA looks forward to representing its members as it participates and cooperates with the Texas HHSC in upcoming workgroups, and the implementation of the viable alternatives to competitive procurement."

Though the efforts of MESA to combat the bid were, I'm reliably told, diligent and consistent, there is no chest-beating in their email release, and no claims of being the reason (or the main reason) for the success of defeating the incontinence bid. MESA makes it clear that it was a team effort, and thanks all involved. 

MESA is and always has been a class act, and from what I'm able to gather from MESA members I know in Texas, the association was instrumental in stopping the incontinence bid as well as doing a great job representing members with a rate-reduction work-group held in a series of meetings in April.

MESA worked hard; MESA worked well and effectively with others; MESA served its members in Texas very well; and MESA did it all without in-your-face, hooray-for-us posturing.

Losers

By "losers" I mean TAHCS. The other email forwarded to me was the one TAHCS sent out. The first problem with their release is the subject line: TAHCS - WE STOPPED COMPETITIVE BIDDING.

Pardon me while I stop and roll my eyes at that ridiculous bit of fiction. TAHCS stopped competitive bidding? TAHCS can't even get a member base because no one takes them seriously; I doubt the TCPA or the HHSC takes them anymore seriously than the rest of us.

TAHCS was one of many working on the incontinence bid problem. I was intrigued by their claim that representatives of the organization "participated in numerous public and private meetings to address the budget shortfall and how Medicaid would be affected," but then I learned that the meetings to address the budget shortfall had nothing to do with the incontinence bid, and realized that it was TAHCS trying to make themselves look more important and more active than they really are.

Again.

The meetings TAHCS is babbling about in the release were the April HHSC work-groups that MESA and other stakeholders participated in to save money for the state to avoid a totally different bid threat.

I really loved this one:
TAHCS' input began in September 2010 and concluded in April 2011 with our last meeting being with HHSC. "We have been working long and hard to find an alternative to competitive bidding and have been met with some success," said Barry Johnson, President TAHCS.

Others involved can say the same thing (only it would  be true in their cases), but I don't recall any word that TAHCS turned in an alternative proposal like MESA did. Barry Johnson, you shouldn't be allowed to communicate without a keeper to make sure what you spout is honest, because every time you and the folks at TAHCS send something out, my BS meter goes wild.

Fools

If you have a copy of the May 2011 edition of HME News, turn to page 13 and read Rob Brant's sob story at the bottom.

It's a shame that competitive bidding puts anyone out of business and that it forces beneficiaries to use different providers. But the truth is that although the current bid system is flawed, any bid system would end up putting some providers out of business.

There are real costs to operating a DME, as Brant rightly pointed out in his little speech at the PAOC meeting. The question in my mind, though, is this: Why did Brant accept a contract if he knew he couldn't afford to do business at the bid rate? How is he more responsible than the out-of-state, inexperienced, or bankrupt companies he rails against?

If Brant knew he couldn't provide oxygen for under $28.77 per month, then accepting a contract with a rate of $21.66 makes absolutely no sense. I understand that he laid off half of his staff and moved into a smaller space. But from the way I read his speech, he knew in July  of 2010 that he couldn't operate on what Medicare was willing to pay him. Why delay the inevitable through April of 2011?

Brant didn't get into the industry activism game until mid-2008; he sat on his hands until then, figuring that someone else would do something that he was just too busy with everyday life to do. Eventually it dawned on him that doing nothing was going to have a direct impact on his own wallet, so that's when he launched AMEPA. He proclaimed loudly that AAHomecare wasn't doing the job (they weren't), yet he's been in bed with them for quite some time now, actively assisting them with their failing strategies and policies. 

The result? AMEPA has accomplished nothing, and AAHomecare still isn't doing the job. This makes sense; I can offer the following mathematical equation to explain the results from the Brant/AAHomecare match-up:

0 + 0 = 0

Liars may figure, but figures never lie.

Rob Brant, "better late than never" works fine when applied to arriving at parties, but not when your livelihood is on the line and the fight needs every person involved. I don't think that your personal activism earlier on would've saved the industry (you're obviously not saviour material), but if all the people sitting on their dead butts would've been consistently active in 2001 and 2002, the industry might not be in the sorry shape it's in today.

You, Rob Brant, were part of the problem, and it was too late by the time you finally got off the spectators' bench for you to be a part of the solution.

So you'll pardon me for not feeling terribly sorry for you, Rob Brant. I feel sorry for the providers who have been in the trenches for almost a decade and who can't seem to find a win no matter how hard they try because so few fight with them. I feel sorry for the beneficiaries who have had problems with the changes caused by competitive bidding. I feel sorry for the people who have believed in you during the last three years and ended up with nothing to show for that belief but your hot air. But I don't feel sorry for you.

The possible silver lining I see from the shut-down of City Medical, Rob Brant, is that you could end up doing us all a favor by going away. 

Please take Barry Johnson with you.

Want Some Cheese With That Whine?

I've heard and read that "someone should do something" about the situation the industry is in.

Tyler Wilson is quoted in HME News as telling DME providers that they need to get involved.

D-U-H!

This isn't news. The whole article is generic, and could have been written at any time during the last eight or nine years. The industry has been told, over and over again, that every one of us needs to be actively and consistently involved.

There are some gems in this particular article; I was especially amused by Walt Gorski saying that we do have influence over lawmakers, and that "steady pressure over time will crack any rock, and, frankly, steady pressure over time makes diamonds."

That cracks me up.

What does Gorski think we've been doing over the last decade? We've tried the steady pressure approach, and has it worked?

Hint: The answer is only "yes" if we've gotten rid of competitive bidding.

Gorski is also quoted as saying that providers need to be vocal about bidding issues, and that "complaints are going to be what drives this program into the ground."

We've been vocal, for years. And though I agree with Gorski that complaints will be what gets rid of bidding, I don't think that it's complaints from our industry that will do the job. The complaints need to come from the beneficiaries in record numbers.

Cut to Hypothetical Round Robin
DME Provider: Congressman X, I don't like competitive bidding, and it's not good for beneficiaries.

Congressman X: How is it not good for beneficiaries?

DME Provider: It inhibits access to care.

Congressman X: You're a caregiver?

DME Provider: I provide important services in the home to patients.

Congressman X: Such as?

DME Provider: Well, I supply the equipment they need at home, which saves the Medicare program millions of dollars each year because my patients aren't in the hospital.

Congressman X: Medical equipment at home is important, but what services do you provide?

DME Provider: I deliver the equipment to their homes; I also take care of repairs if their equipment needs fixing or maintenance.

Congressman X: Sears delivers and honors warranties too. What services do you provide?

DME Provider: My business is on call 24/7 if a beneficiary has an emergency with his equipment.

Congressman X: Well that's a plus. But I've heard from your national association that your industry provides care in the home, and so far what you're telling me is that you provide medical equipment in the home, but no care.

DME Provider: We do set-up, and teach the patient how to operate the equipment we've delivered.

Congressman X: So does Best Buy.

DME Provider: Sir, our costs of business keep going up, but reimbursements are being slashed. The Medicare program requires that we continue to do business according to specific and costly standards, but it's getting harder and harder to do that in these hard economic times. I need your help, and ask you to support legislation that will repeal competitive bidding.

Congressman X: Competitive bidding for DME is expected to save the government $20 billion dollars. We have a deficit of over $14 trillion dollars. We all have to tighten our belts and find ways to cut everywhere we can. I'm a supporter of small businesses, and understand your concerns. But these are tough times, and entitlement programs have to be trimmed too.

DME Provider: Beneficiaries don't like competitive bidding where it's been implemented.

Congressman X: My district is in a round-one bidding area, and my offices haven't had one complaint from any beneficiaries.

DME Provider: But there have been problems at discharge and a lot of confusion. Medicare didn't educate the public or hospitals or doctors adequately.

Congressman X: My understanding is that these situations have tapered off, and that things are running more smoothly now. Any new program is going to have bumps in the road, especially programs as big as competitive bidding. CMS tells Congress that the competitive bidding is saving money and that beneficiaries are receiving the products they need at better prices. Fraud is also being drastically reduced in the bid areas, and that's going to save the program money too.

DME Provider: Sir, with all due respect, the reimbursements in the bid areas are too low. They're going to drive many of the bid winners out of business.

Congressman X: But the reimbursement rates were arrived at by the amounts providers themselves bid. How can the rates be too low?

DME Provider: We call the people who bid too low in an effort to secure contracts and make up for the low reimbursements in bulk "suicide bidders." CMS didn't do enough to eliminate those bids from the program, and because of that the rates are too low. The agency said that bids too low would be thrown out, but that didn't seem to happen, and now my industry is suffering. CMS should have done a better job.

Congressman X: How is CMS responsible for the unsound bids submitted by the industry's businesses?

DME Provider: CMS should have known those bids were too low and rejected them.

Congressman X: CMS has to work with what it's given. If the agency was given low bids, then the final reimbursements would be low. The responsibility for that lies with the bidders. But let me ask you this: lower reimbursements mean lower co-pays for beneficiaries, don't they?

DME Provider: Yes, beneficiaries have a reduced co-pay for the products and care we provide to them.

Congressman X: What care?


Does that conversation seem ridiculous? It shouldn't, because I've had several like it. Legislators and their aides are always polite and respectful, but if they're familiar with the program, and they have even a vague understanding of the industry, they know what we're going to say before we say it.

Our arguments against bidding are so thin they're almost threadbare.

We can't expect the repeal of a program that is expected to save the government $20 billion, especially if we don't have a pay-for to offer. It's nice of Dean Rosen, yet another lobbyist that AAHomecare is paying, to tell us that we need to be part of the solution (thanks for doing what AAHomecare does best by pointing out the obvious, Dean), but we have nothing to offer because we have no cohesive plan compounded by pathetic leadership.

Round Two Delay
For those of you heartened by the delay, don't be. Though CMS is talking "potential structural changes," the fact is that a "changed" competitive bidding is still competitive bidding. Team Credibility at AAHomecare might be trying to tell us that the delay gives us a chance to get more support for HR 1041, but the truth is the political climate is unfavorable to us, and without big support in the Senate, this year's bill will fail just like last year's bill.

I believe in hope, though it may appear that I don't. But I don't believe in false hope. HR 1041 is, to me, AAHomecare trying to look busy, and I'm not buying into it; I'm smarter than that.

Pity Party
Poor Rob Brant. He's going to close his business at the end of this month.

It's not as though he was that invested in his business lately; Brant had moved to Atlanta. How does one "manage" and nurture a small business in Miami from Atlanta?

Oh, that's right. Brant was more interested in his 15 minutes of annoying those of us in the industry who have taste and who can think on our own.

I've said it before and I'll say it again: If Brant and his cronies, along with a lot of other worthless do-nothings, had gotten involved in the fight before 2008, we might be experiencing a different, more friendly reality today. No, I'm not implying that Brant would have ended up the savior he's made himself out to be; that's a concept that's too ridiculous. But he sat on his hands until it was far too late.

Brant has been abrasive, arrogant, and annoying. He has oozed his way into the limelight, and has managed to smarm himself onto the AAHomecare board. With the closing of his business, he ought to go find something else to do and give the rest of us some peace. He should take Barry Johnson and Dean Cheney with him, too, but we won't get so lucky. My guess is that Brant is going to sell himself as some kind of industry expert and charge for consulting. Or, worse yet, become a lobbyist, which his track record of success would clearly support. Not.

It hurts when I laugh that hard.


Whine and Cheese
When we talk to legislators or aides, we can't make the same pitch we've been making for year and years. We can't sustain the myth that we provide care in the home. If the beneficiaries aren't behind us, we're spinning our wheels. Our strategy needs to be focused on them; our mission is to get them motivated and vocal. We can contact our legislators and storm the Hill all we like; we're not a strong enough lobby on our own. Until the beneficiaries are doing it with us, we're going to go nowhere fast, so that's where we need to focus our efforts. We need to get them good and mad.

MSNBC Strikes Again

An article on MSNBC today has once again demonstrated the site's genius for pointing out the obvious in an article called "Florida is 'Ground Zero' for Healthcare Fraud."

That's almost as dumb as HomeCare Magazine's tendency to seek out Rob Brant and Barry Johnson for pearls of wisdom they're so obviously ill-equipped to provide.

MSNBC and NBC reporters seem to like doing stories about Medicare fraud in Florida. We all know about the fraud problems in that state; it's a mecca for retirees, so of course there will be more fraud there than, say, Wisconsin. Or Alaska. I think it's fair to say that where there are large number of beneficiaries, the chances that fraud will be committed increase.

It's useless to try to tell the press to use more current statistics, and it's pointless to tell them how our industry is being beaten up by competitive bidding and all the requirements we've been slapped with the last couple of years. The article zooms in on Miami, and rightfully so; Miami has long been notorious for Medicare fraud, and is probably responsible for a large part of the industry's awful reputation. Yes, other cities in other areas have contributed (Houston, for example), but Miami is king when it comes to fraud.

I'll probably get some complaints from Miami providers, but don't wait for an apology. Cliches exist for a reason, and where there's smoke there's fire. I don't know what the fraud stats are for Orlando, but I was completely unsurprised when Miami was in round one of competitive bidding. I think I might have been outraged if it hadn't been.

The article tells us that Medicare systems were set up and run on the assumption that those billing are honest; though the writer points out the flaws in agency staff, those billing are, of course, the bad guys of the story. What's wrong about that is that there are honest people who provide products and submit for reimbursement.

We know that back in the day, being in DME was lucrative, and business owners made a tidy sum from Medicare. But fraud isn't new, and it's taken CMS an incredibly long time to make changes that will enable them to fight the drain more effectively. If a company is billing for an unusual number of, say, left arm prosthetics, and it's not caught, then the system isn't run or policed well.

One the one hand, it's terrible that CMS seems to be able to evade responsibility for not doing more sooner. On the other hand, it's almost tragic that there are people out there actively looking for ways to beat the system and stick it to the taxpayer. The only thing wrong with assuming honesty is overlooking the fact that there's a lot of larceny out there.

Sometimes you can't appeal to a person's better nature because the person in question simply doesn't have a better nature. The entitlement mentality has taken a stranglehold on a huge portion of this country's population, and to those people, getting something for nothing is their right because they think it's owed to them.

When did that happen to us? My parents didn't raise me that way, and I didn't raise my children that way. I appear to be an exception rather than the rule; I can't go anywhere anymore without children running wild and their parents ignoring them or asking them to behave instead of making them act like people instead of animals. During the last twenty years, the trend in parenting has been to be "friends"' with your children instead of parents; we're told to not scar the little darlings by imposing punishment, and making them face consequences for their actions is a shocking idea anymore.

If the government thinks it's having a hard time with fraud now, I shudder to think of what's going to happen as the youngsters in this country come of age.

I'm not saying anything most of you haven't thought privately, but no one talks about it and no one does anything about it. And it's sad, because it's a symptom of the decline of our society and our country.

So there are more investigators on the streets now to combat the fraud problem. The people who go into business to commit fraud know the risks; they're sure they won't get caught, but they know the risks, and I'm guessing that the police don't frighten them because of the lure of a big (and unearned) payday.

It's important to catch the bad guys. But it's more important to fix the system that the bad guys target. CMS has wasted more than a decade doing nothing except pointing the finger at everyone else but the agency staff and agency subcontractors who know a problem exists but do nothing worthwhile to stop it.

I don't see competitive bidding as worthwhile. Deliberately depopulating an industry via a flawed program in the name of reducing fraud is ridiculous. I'm ignoring the "savings" associated with bidding because CMS has always been in control of reimbursement rates; if they wanted to save money, all they had to do was change the fee schedules.

The slant in fraud articles is painfully obvious. There is no more unbiased journalism anymore, and I'm tired of it. Reporters almost always fail to have any meaningful dialogue with anyone in the industry; our side of the story is almost never told. I don't want the press talking with anyone at AAHomecare or, worse yet, Rob Brant and (or) Barry Johnson (or anyone from that group), because they don't accurately or adequately represent DMEs (some of them are actually embarrassing). I don't want to read anymore vapid quotes from the usual suspects; we don't need trite, and we don't need to feed the egos of the hollow who look only to serve their own interests and further their own agendas.

I vaguely recall that AAHomecare had hired a PR firm not too long ago to improve the industry's image. I don't know how much that firm was paid, but I haven't seen a single positive result from that investment; it's yet another failure in a list of failures brought to us by AAHomecare. Our "voice in Washington," which has no credibility on the hill, can't even buy us a better image.

Epic fail, AAHomecare. Again.

I don't know what the answer is. But I'm frustrated, and very sick of being the victim of a smear campaign conducted by CMS and the press. Maybe I'll take action by contacting the MSNBC advertisers and telling them I'll boycott them if they continue to advertise on a site that runs stories that are half-true.

It's somewhere to start.

Plan Z

The usual feel-good spin has begun.

You Spin Me Right 'Round Baby Right 'Round
I don't mind feeling good; in fact, I'm strongly in favor of it. But what I don't like is when my hopes are raised and then dashed because there's no substance behind the spin that raised them in the first place.

So I'm skeptical, but not unjustly so.

We've all been down the legislative road trying to get competitive bidding repealed. And we've all seen just how successful those efforts were.

I actually get angry when I read articles in the industry press that offer a sunshine-and-kittens take on the latest bill to be introduced in the House of Representatives.

HME News trumpets that it looks like "providers had the luck of the Irish" during AAHomecare's ridiculous legislative conference; the article has Tyler Wilson gushing about how the bill has "infused the conference with excitement" (pardon me while I gag), and one of the bill's authors (Thompson) telling the industry to "put a face" on the issue and "really drive it home."

Hold on a second; I need to gag again.

The latest bill that Tyler Wilson really needs to succeed isn't anything new. Anyone out there who believes that any bill introduced that's meant to repeal competitive bidding and doesn't have some kind of cost to the industry is an idiot. Altmire and Thompson want to use money set aside for other projects that was never spent as a pay-for? I'll believe it when I see it happen, and here's why: There are more pressing things that our government could use that money on. Getting rid of competitive bidding is important, but I can think of several things to spend "spare" money on, and I'm betting that there are others who want to use that money too.

Does our government really have any "spare" money? We have an enormous deficit. Our government cannot and should not continue to spend money it doesn't have. Not even to serve a special interest.

Thompson tells us to put a face on the issues. What does that man think we've been doing since before MMA 2003? Year after year we've marched to the Hill and made the rounds trying to put a face on the issue and to really drive it home. And every year we've failed.

So I looked at what HomeCare Monday had to say about the bill; I'm going to start off by giving them a very black mark for quoting Rob Brant.

Thank you, Rob, for once again pointing out the obvious; the village idiot could figure out that the industry needs to get previous supporters signed on again, and that we need as many of the freshmen Reps as we can get too.

What would we do without you, Rob Brant? And thanks so much, HomeCare Monday, for turning to Brant for yet another vapid quote. I suppose I could be grateful that you didn't quote Tyler Wilson, but the truth is that though I think neither Brant nor Wilson is credible (or useful), Wilson has a tiny bit more standing than Brant.

Where's the Love?
The industry can probably get a decent number of supporters in the House. Unlike Senators, Representatives have districts, and so they have a smaller gene pool of voters to rely on for re-election. Representatives need to be more engaged because they can't pull voters from the whole state.

If this new bill doesn't get support in the Senate, it's as dead as last year's bill. So though AAHomecare, NAIMES, and the industry press are putting a positive spin on the legislation, the fact is that it's probable that we're going to get as far this year as we did last year.

Failure is still failure, and we don't appear to have any friends in the Senate.

One person quoted in HomeCare Monday said that there were 250 at the conference, but there should've been 2,500 there.

That may be true, but that conference is expensive, and in the end, it has never led the industry to any kind of victory. Yes, it's an event that has one portion designed to get attendees on the Hill to lobby. But where has that lobbying gotten us? Who among us can really afford to invest in something that offers no return? I see AAHomecare's legislative conference as a cash cow for the association. I've attended it, and I've lobbied during it, and nothing has changed.

So if AAHomecare isn't "feeling the love" through event attendance, it has only itself to blame.

The Warrior
I concede that the current effort has to be made. I do not, however, have any faith in our industry "leaders" to steer it to a successful end. It's their pesky track record, you see, that makes me look at them with a complete lack of confidence.

Giving feel-good, rah-rah snippets doesn't make me enthusiastic about our chances, because I see this maneuver as a rerun of previous identical maneuvers. I see this as doing the same thing over again and expecting different results.

As far as I can tell, AAHomecare still has no "hand" in D.C. I continue to see posers (I'm talking to you, Rob Brant) trying to appear worthy and intelligent (good luck with that). And I see too many state association leaders still mindlessly following and publicly supporting the agenda of AAHomecare; the one that's let us down again and again and again.

I prefer more backbone and more independent thinking in my state (or regional) association leaders, but it would appear that that is a very rare commodity. There are one or two out there who don't have the flock-of-sheep mentality (I've heard from some of its members that MESA has no problem telling AAHomecare what it thinks, and if that's true I wish it was a virus that others would catch), and at the end of the day, the members of the associations suffer from the failure of state leadership to take a stand and demand accountability of the ones presuming to lead in the national arena.

It's not true that a bad leader is better than no leader. We've had a decade of bad leadership, and the proof of that is where we find ourselves today. We need a warrior.


Under Pressure
"These are the days it never rains but it pours." We have to give ourselves one more chance, because to do nothing is to give up. But to do the same thing we did before -- and that resulted in failure -- isn't going to do the job. We need a Plan Z, and we need it fast. We shouldn't rely on just one action initiated by flawed leadership, or we'll waste yet another chance.

Like we can afford that.

The Blind Leading the Blind Times Two

Over the weekend someone forwarded an E-mail to me that urged providers to attend a "mock auction" that an economist, Peter Cramton, is holding.

NAIMES has been asking people to go, telling them that it's urgent because "it may be the only chance we have to show that an auction will not work for healthcare. We must be there to share the variables and help Cramton understand the DME industry."

Really?

Cramton isn't going to do this to show that an auction that he favors won't work. He's wanting to do a demonstration of how competitive bidding can work. This mock auction isn't a forum for DME providers to make themselves heard; with all the lobbying that's been done over the last eight-plus years, we've had a ridiculous number of opportunities to say what we've had to say.

There is a difference between not being heard and not being listened to.

Cramton thinks he can show CMS a better way to do bidding. He is not telling CMS that bidding won't work for healthcare. DME providers attending this farce are sending one message and one message only, and that's that the industry supports Cramton's take on bidding.

Readers, if CMS was truly interested in what providers had to say, the agency would've been more responsive to us. Round one has rolled out, and CMS is telling everyone what a great program it is. If CMS is showing interest in Cramton's mock auction, they're doing so not to support a repeal, but to get ideas for future rounds.

One state association leader calls Cramton's work "too important to ignore."

Huh?

Cramton's work is only "important" in that its premise is that the current program won't work as is. And that's where the "importance" of the work ends. Cramton is not our industry's champion; he's out to prove that his version of bidding is better.

Do you support that? I don't. I want competitive bidding repealed, not retooled. The mock auction is not about making ourselves heard, and it's not about making CMS rethink competitive bidding. Industry providers and industry "leaders" can attend this event and make noise when they don't like something, but that's not going to change the focus of the event and it's not going to give us any advantage.

One "leader" said something about the mock auction being an opportunity to have a "discussion."It's not an industry-designed or industry-hosted event. It's an event that people are expected to pay to attend (at $80.00 per person, which no doubt goes into Mr. Cramton's pocket; it's nice of us to line the pockets of a man who wants to teach CMS to build a stronger program) for the privilege of seeing an economist tell CMS how to continue to make it impossible for us to do business.

A discussion? I won't name the "state leader" who came up with that bit of brilliance (this time). But considering how often the individual in question waffles and sucks up to AAHomecare, I guess I'm not surprised. Disappointed, but not surprised. He should be ashamed.

I think that any right-thinking person should boycott this and focus on telling legislators that we are opposed to the continuation of competitive bidding in any form; even that of Peter Cramton.

And I think that any industry "leader" who supports Cramton should be a leader no more.

Speaking of Leaders ... 
AAHomecare is doing what it's always done but has never gotten results from.

I've always defined insanity as doing the same thing over and over again but expecting different results.

AAHomecare has persuaded yet another Representative to introduce what's being called a "budget-neutral" bill that will repeal competitive bidding.

Deja vu!!

How many of the past bills to repeal the program have been successful? I can count them on the toes of one hand.

So those of you who are storming D.C. will be able to ask your Representatives to support the bill. And Tyler Wilson is patting himself on the back, expecting the industry to think that he and AAHomecare are the greatest things since sliced bread.

The last bill, introduced by Meek, got 259 supporters, but never got out of committee and never got a single Senator willing to touch it. AAHomecare is saying that people can now go to legislators and talk about the "real" problems with round one: problems with access, confusion, and extra costs because patients can't be discharged as quickly.

Readers, the program was implemented January 1st. We're now in the middle of March. Did anyone honestly expect that implementation of a program so big would have no hiccups? I read about the "problems" in the industry press and from other industry-sympathetic sources, but I have to ask myself this: Are the number of problems increasing? Are they decreasing?

In the long run, competitive bidding will save the Medicare program and beneficiaries money. Lower reimbursements mean lower co-pays, and so seniors aren't shelling out as much if they don't have co-pay coverage.

I don't see how any bill that repeals competitive bidding can begin to be "budget-neutral," and fully expect that the score the legislation will receive will show that my skepticism is right, unless the intent is to slash reimbursements as the pay-for. I don't know about you, but my rising costs of doing business don't allow me to continue to do business by making less money.

I won't need competitive bidding in my area to put me out of business if the already-low reimbursements are cut even more. That's the harsh reality of DME, and people who have no experience running a DME (I'm talking to you, Tyler Wilson) shouldn't be making promises and deals on my behalf that I'm very sure I can't afford. People who answer to boards ruled by big companies with far deeper pockets than I have just don't have a firm grip on the difficulties of running a small industry business, and I'm not interested in following those types (I'm still talking to you, Tyler Wilson).

Do I want to see competitive bidding repealed? Yes. Do I think that AAHomecare's latest attempt at a bill will succeed? No. AAHomecare has handed the industry failure after failure, and I don't see that they've done anything new that's going to change the association's losing streak. I think they're ineffective, and history bears out my judgment.

Too Many Problems and No Solutions
AAHomecare isn't the answer; Peter Cramton and his "mock auction" isn't the answer. I'm going to try to ignore Tyler Wilson and his "go me" posturing; I recognize a bunch of hot air when I hear it.

I'm absolutely boycotting Cramton's event, because I don't want my presence to be construed as supporting a revised method of bidding that might actually work.

I want to serve my patients and earn an honest living. I know that I have to be involved to get rid of competitive bidding, but I'm not interested in doing the same things over and over again and expecting different results. I don't know what the solution is, but I know what -- and who -- hasn't worked, and I don't think it's unreasonable of me to think what I do.

What troubles me are the people who will believe in yet another bill and who will believe that they're going to "be heard" at Cramton's event, and that things will change as a result.

I don't like being let down, and so I choose to travel the road of realism. I don't put my faith in false prophets.