I keep reading in the industry press that the bid process is "flawed." I don't know about you, but it never crossed my mind that any DME provider would praise the fairness and correctness of the bid process (RoTech came closest to doing so in its statement, but even they fall short of congratulating CMS on a job well done).
Let's stop pretending to be surprised by the current returns and take a look at the "flaws" that the providers themselves contributed to the selection process, because some of the responsibility for the bid reimbursement rates lies on the industry's shoulders.
Garbage In, Garbage Out
In the original round one, the "leaders" of the industry preached, over and over again, how important it was to turn in bids that weren't too low. Everyone knew that CMS was going to average the bids received from a CBA and set the reimbursements based on them, so responsible bidding was imperative.
Little changed in how CMS was going to handle the round one rebid; there were a few tweaks here and there, but fundamentally speaking, the process didn't change. That was pretty well-known by all going into the the rebid.
It seems pretty clear that no one in the industry learned anything from the original round one process. Despite the "no suicide bidding" campaign, low-ball bids were, quite obviously, submitted. Let's take a look at some examples, then and now, for a couple products in a few bid areas.
E0470
Miami
First bid rate: $159.90
Rebid rate: $147.57
Dallas
First bid rate: $169.36
Rebid rate: $150.00
Kansas City
First bid rate: $170.90
Rebid rate: $144.26
Orlando
First Bid rate: $156.00
Rebid rate: $130.00
I'm wondering, based on what I see above, if in some of the CBAs, there wasn't some kind of weird "how low can you go" contest.
K0835 (RR)
Miami
First bid rate: $324.59
Rebid rate: $285.00
Dallas
First bid rate: $328.65
Rebid rate: $275.39
Kansas City
First bid rate: $385.60
Rebid rate: $330.47
Orlando
First Bid rate: $324.59
Rebid rate: $293.55
Did this item suddenly become that much cheaper cheaper to supply?
The Buck Stops Here
No matter how unpleasant and no matter how unwanted competitive bidding is, it was (is) the responsibility of the bidders to submit responsible, feasible bids. It was (is) the responsibility of the bidders to determine what their actual costs of doing business are and prepare appropriate bids.
Each bidder turned in financials to CMS to be considered for contracts. If a bidder says that he can provide a product or service at a specified dollar amount, it is not the responsibility of CMS to question that (not unless the bid is so ridiculously low that even the agency laughs at it). No one knows a business like its owner (or manager), and so CMS has to assume that a bid rate submitted is a reasonable one for the company.
CMS is not to blame for a bidder's stupidity, or greed, or fear, or combination of the three. For the new reimbursement rates to be so much lower than they were in the original round one process is, in a word, crazy.
If there were providers out there who submitted low bids because they were afraid of not being selected in the rebid (this might be doubly true for those rejected in the original bid), or if there were providers out there who submitted low bids because they reasoned that they'd make up a financial shortfall in increased referrals, I can only wonder how long it will be before they're experiencing the joys of bankruptcy (a much-deserved bankruptcy, all things considered).
The articles in the industry press seem to make it clear that the industry is blaming CMS for the low reimbursement rates; even Lincare is saying that "pricing mechanism used by CMS to determine the payment rates ... is fundamentally flawed." This may be somewhat true, but the baseline CMS used came from bids submitted by providers.
The industry howled about the reimbursement rates from the original bid. Yet in the rebid process, the same industry submitted lower bids (on average) that generated lower reimbursement rates. What's wrong with this picture?
Along Come the Anomalies
So CSI:HME wants bidders to give them information that will enable them to "approach Congress with some real data" and with "anomalies" such as:
1. A bidder could bid to supply up to 20 percent of the market with no verification that it could actually meet the demand, and could choose never to honor the bid, yet the prices it offered will set the prices other bidders will receive.
2. A bidding supplier could be offered a contract where payments it receives would be 20 percent or more lower than its bid.
This isn't new; why was this "real data" and the "anomalies" not taken to Congress right after the original round one was scrapped?
Confusion to Your Enemies!
No, not at the moment; all the confusion seems to be within the industry, not CMS.
The industry doesn't have a sound, cohesive strategy. The industry doesn't have sound, cohesive leadership (that's most definitely true for the johnny come lately organizations that excel at shameless self-promotion but that offer nothing new and nothing effective).
The classic definition of insanity is doing the same thing over and over again and expecting different results. The DME industry has, for the last decade, done the same things over and over again, and can't seem to understand why it doesn't get different results. In a word (or a grunt as the case may be): DUH! It's time to do something else!
In the meantime, maybe the dismal showing of the round one rebid will teach those slated to participate in round two to not submit bids from the basement.
Maybe.
Wednesday, July 28, 2010
Wednesday, July 21, 2010
DME, the Press, and Fraud
I've been thinking about the Mike Thomas commentary published in the Orlando Sentinel on July 14. There's been a lot of buzz about it and, of course, a very negative reaction to it from the DME industry. That's to be expected, considering how negative the commentary was.
The comments about it on the Sentinel's site are about what I'd expect to see and the poll results are what I'd expect as well. I think it's very fair to say that the vast majority of those who commented and who participated in the poll are people who have a vested interest in the future of DME. Am I surprised? No.
Mike Thomas's scenario about how the fee schedule works had to be tongue-in-cheek; no one with even the smallest amount of intelligence could present it as or believe it to be plausible. He bases it, he says, on the articles that have appeared in the Miami Herald, which were, apparently written by investigative reporters who go take a look at Medicare fraud every so often.
To those who took Thomas to task about his apparent failure to do any independent research on the topic, I can honestly say that I agree with that criticism. If one is going to do a commentary on something, one should make oneself as knowledgeable as possible before writing the article. I don't see how Thomas could have a valid, informed opinion based on a single source, but it seems obvious that he and the Orlando Sentinel are fine with it.
What Mike Thomas is correct about is that there is a fraud issue. He had to get this "Medical equipment suppliers in the Southeast, based mainly in Miami-Dade, used the names of 2,454 dead doctors for prescriptions to file Medicare claims and got paid $3.9 million in reimbursements from January 2007 to the end of June…" from somewhere.
Yes, there is licensure and there are criminal background checks in Florida, which should, in theory, make it impossible for criminals to get into DME. Despite these requirements, fraudulent billing continues, and the people who do so are criminals. To pose the licensure and background check argument is (let's be honest here) somewhat ingenuous. We all know that a determined person will, in most cases, find a way around a system. It happens all the time. It shouldn't, but it does.
Another argument tossed at Thomas by those who commented on the Orlando Sentinel's website is that beneficiaries will lose services. I don't know a lot about the bid demonstrations in San Antonio and Polk County (FL), but did the beneficiaries in those two areas complain about loss of services or loss of equipment accessibility (or both)? The winners of the bids will have to continue to offer repair and maintenance services on the equipment they provide.
One commenter offered this: "Legitimate med equipment suppliers provide SERVICES to customers. The type of service that no one from Amazon is going to provide. For instance, do you think that Amazon is going to come out to a patient’s home at 2am during a hurricane and provide emergency oxygen tanks to a critically ill patient without power." Does Amazon provide oxygen? Of course not, which makes that portion of his comment rather ridiculous. That same person continued with a more legitimate argument about personal delivery, set-up, and adjustments to other DME items that Amazon may or may not sell, and that's some of what Thomas missed.
DMEs - honest DMEs - do those things. And doing things like that cost the provider money. Added costs of doing business are licensure (if required), accreditation, the various required insurances, staff salaries and any related benefits, equipment purchase, and so on. There are real costs of doing business for providers, and those costs aren't going down. But there are costs involved with doing business (any business), and if you choose to be in the business, you're going to have to meet them. Whether or not those costs are fair isn't the point.
Framing an argument of patient harm is premature. Another person who posted on the Sentinel's site said this when a poster said to stop posting scare rhetoric: "It's not scare rhetoric. It's exactly what happened when the program was first tried and subsequently repealed in 08. Check the facts and see for yourself. The flaws in the program have not been addressed well enough to not compromise patient care. If it goes through as is, you will see the results will be the same as they were in 08."
What patient care was compromised in 2008? Who was harmed by the program in 2008? No one was because the delay in the doc fix prevented the implementation of the original round one bid. To state otherwise undermines the credibility of the industry, and harms the legitimate statements made about it. Perhaps that particular poster should have checked his own facts? Yes. He certainly should have.
I think everyone has known for a long time that the DME industry has a severe image problem (it isn't totally undeserved, even though ethical providers suffer from it). Nothing it (the industry) has said or done has seemed to solve the problem. There have been vague rumblings about the industry policing itself, but is that a realistic answer? I'm going to say no, and here's why.
I've heard rumors (they're unconfirmed, I admit that, but they're persistent and consistent) that there was a provider who was "investigated" by a local news station that had complaints from the public. This news station contacted one of the state associations, asking for a referral for another provider who could loan a power chair that the news station could take to the suspect provider to see what the repair estimate would be. This the association did, and that's all the association did. A small adjustment was made to the power chair to render it inoperable, and it was taken to the suspect provider, who gave an estimate of more than $3,000.00 for repairs that did not address the $10.00 adjustment that would have fixed the power chair. When the beneficiary expressed dismay over the amount of the estimate, the suspect supplier told the beneficiary not to worry because Medicare would pay for it.
Needless to say, the suspect provider was furious for having been exposed, and incorrectly blamed the association. He was angry enough to complain to a major industry manufacturer who, instead of supporting the association and the exposure of a supplier of apparently questionable business practices, withdrew its support from the organization that really had no involvement. I can only conclude that the manufacturer in this story (who won't be named at this time) chose to ignore the obvious and look at its bottom line instead. Shameful!
An interesting side note is that when the story aired on television, the supplier who supplied the power chair got angry calls from others in the industry, not support. Ridiculous!
This is why the DME industry has the reputation it has, and this is why the DME industry cannot police itself.
I think it's a very good thing that Mike Thomas didn't know about the power chair incident, because it makes most involved look very bad, but it illustrates the hypocrisy within. If you want to improve the DME industry's reputation, closing ranks with suspect providers and punishing the whistle-blowers is not the smartest way to go about achieving the goal. In fact, it's pretty darned stupid.
If the industry is going to preach ethics and professionalism, then the industry should practice ethics and professionalism. If someone from within has the courage to take an active stand on fraud, angry phone calls should not be the result. My point? The next time someone prints a negative story about DME, ask yourself what you're doing to improve the industry (and its image), and what you're doing to support those who are making an effort to clean it up. It's not enough these days to quietly go about your business, no matter how honest and ethical you are. For decades the criminals have shaped the image. You also have the power to shape it in the other direction. It's up to you to put forth the effort and to actively support those who go out on a limb to expose those who don't belong.
The comments about it on the Sentinel's site are about what I'd expect to see and the poll results are what I'd expect as well. I think it's very fair to say that the vast majority of those who commented and who participated in the poll are people who have a vested interest in the future of DME. Am I surprised? No.
Mike Thomas's scenario about how the fee schedule works had to be tongue-in-cheek; no one with even the smallest amount of intelligence could present it as or believe it to be plausible. He bases it, he says, on the articles that have appeared in the Miami Herald, which were, apparently written by investigative reporters who go take a look at Medicare fraud every so often.
To those who took Thomas to task about his apparent failure to do any independent research on the topic, I can honestly say that I agree with that criticism. If one is going to do a commentary on something, one should make oneself as knowledgeable as possible before writing the article. I don't see how Thomas could have a valid, informed opinion based on a single source, but it seems obvious that he and the Orlando Sentinel are fine with it.
What Mike Thomas is correct about is that there is a fraud issue. He had to get this "Medical equipment suppliers in the Southeast, based mainly in Miami-Dade, used the names of 2,454 dead doctors for prescriptions to file Medicare claims and got paid $3.9 million in reimbursements from January 2007 to the end of June…" from somewhere.
Yes, there is licensure and there are criminal background checks in Florida, which should, in theory, make it impossible for criminals to get into DME. Despite these requirements, fraudulent billing continues, and the people who do so are criminals. To pose the licensure and background check argument is (let's be honest here) somewhat ingenuous. We all know that a determined person will, in most cases, find a way around a system. It happens all the time. It shouldn't, but it does.
Another argument tossed at Thomas by those who commented on the Orlando Sentinel's website is that beneficiaries will lose services. I don't know a lot about the bid demonstrations in San Antonio and Polk County (FL), but did the beneficiaries in those two areas complain about loss of services or loss of equipment accessibility (or both)? The winners of the bids will have to continue to offer repair and maintenance services on the equipment they provide.
One commenter offered this: "Legitimate med equipment suppliers provide SERVICES to customers. The type of service that no one from Amazon is going to provide. For instance, do you think that Amazon is going to come out to a patient’s home at 2am during a hurricane and provide emergency oxygen tanks to a critically ill patient without power." Does Amazon provide oxygen? Of course not, which makes that portion of his comment rather ridiculous. That same person continued with a more legitimate argument about personal delivery, set-up, and adjustments to other DME items that Amazon may or may not sell, and that's some of what Thomas missed.
DMEs - honest DMEs - do those things. And doing things like that cost the provider money. Added costs of doing business are licensure (if required), accreditation, the various required insurances, staff salaries and any related benefits, equipment purchase, and so on. There are real costs of doing business for providers, and those costs aren't going down. But there are costs involved with doing business (any business), and if you choose to be in the business, you're going to have to meet them. Whether or not those costs are fair isn't the point.
Framing an argument of patient harm is premature. Another person who posted on the Sentinel's site said this when a poster said to stop posting scare rhetoric: "It's not scare rhetoric. It's exactly what happened when the program was first tried and subsequently repealed in 08. Check the facts and see for yourself. The flaws in the program have not been addressed well enough to not compromise patient care. If it goes through as is, you will see the results will be the same as they were in 08."
What patient care was compromised in 2008? Who was harmed by the program in 2008? No one was because the delay in the doc fix prevented the implementation of the original round one bid. To state otherwise undermines the credibility of the industry, and harms the legitimate statements made about it. Perhaps that particular poster should have checked his own facts? Yes. He certainly should have.
I think everyone has known for a long time that the DME industry has a severe image problem (it isn't totally undeserved, even though ethical providers suffer from it). Nothing it (the industry) has said or done has seemed to solve the problem. There have been vague rumblings about the industry policing itself, but is that a realistic answer? I'm going to say no, and here's why.
I've heard rumors (they're unconfirmed, I admit that, but they're persistent and consistent) that there was a provider who was "investigated" by a local news station that had complaints from the public. This news station contacted one of the state associations, asking for a referral for another provider who could loan a power chair that the news station could take to the suspect provider to see what the repair estimate would be. This the association did, and that's all the association did. A small adjustment was made to the power chair to render it inoperable, and it was taken to the suspect provider, who gave an estimate of more than $3,000.00 for repairs that did not address the $10.00 adjustment that would have fixed the power chair. When the beneficiary expressed dismay over the amount of the estimate, the suspect supplier told the beneficiary not to worry because Medicare would pay for it.
Needless to say, the suspect provider was furious for having been exposed, and incorrectly blamed the association. He was angry enough to complain to a major industry manufacturer who, instead of supporting the association and the exposure of a supplier of apparently questionable business practices, withdrew its support from the organization that really had no involvement. I can only conclude that the manufacturer in this story (who won't be named at this time) chose to ignore the obvious and look at its bottom line instead. Shameful!
An interesting side note is that when the story aired on television, the supplier who supplied the power chair got angry calls from others in the industry, not support. Ridiculous!
This is why the DME industry has the reputation it has, and this is why the DME industry cannot police itself.
I think it's a very good thing that Mike Thomas didn't know about the power chair incident, because it makes most involved look very bad, but it illustrates the hypocrisy within. If you want to improve the DME industry's reputation, closing ranks with suspect providers and punishing the whistle-blowers is not the smartest way to go about achieving the goal. In fact, it's pretty darned stupid.
If the industry is going to preach ethics and professionalism, then the industry should practice ethics and professionalism. If someone from within has the courage to take an active stand on fraud, angry phone calls should not be the result. My point? The next time someone prints a negative story about DME, ask yourself what you're doing to improve the industry (and its image), and what you're doing to support those who are making an effort to clean it up. It's not enough these days to quietly go about your business, no matter how honest and ethical you are. For decades the criminals have shaped the image. You also have the power to shape it in the other direction. It's up to you to put forth the effort and to actively support those who go out on a limb to expose those who don't belong.
Monday, July 19, 2010
The DME Industry and Competitive Bidding: The Industry Heroes
Forgive me for starting with the obvious: healthcare in the United States is a mess. Though each segment can be held up as an example of that statement, the DME (or HME) industry and its current situation is a great illustration of healthcare gone wrong.
I'll give a brief primer for those unfamiliar with DME.
The Introduction
Most DMEs bill Medicare for products needed by and delivered to the program's beneficiaries. The DME doesn't name the prices for the products, Medicare does via its fee schedule. That's an important statement that Joe Average citizen often doesn't know. If a DME is willing to accept the Medicare reimbursement rate, then the DME can bill the program for reimbursement. Yes that's an oversimplification, because DMEs must meet specific criteria to be accepted providers, but the important thing here is that DMEs have no control over what Medicare will or will not pay.
The fee schedule has seen many changes over the years. In the beginning, DMEs did name their own prices for products, and as a result Medicare over-paid. When the Medicare program finally caught on to over-paying, it introduced the fee schedule. Reimbursements have been cut many times since its introduction as CMS has caught on to what things really cost DMEs, which in turn has cut into profits.
The 2010 budget for Medicare was proposed at $453 billion which is a 6.5 percent increase from 2009. Medicaid was to be funded at $290 billion in 2010, up 12 percent from 2009.
Some of the claims that are submitted to Medicare are, unfortunately, fraudulent. I'm not talking about errors made by billers, which CMS seems to lump in with fraud statistics. I'm talking about DMEs who submit claims for products not actually provided to beneficiaries and other "creative" billing strategies that benefit no one but the provider doing the billing. And though DME costs for Medicare are a tiny fraction of the agency's budget, the agency claims that DME fraud is a huge issue (to the tune of $700 million in improper payments).
The Solution That Isn't a Solution
Medicare has made a big deal, in the press and with Congress, about DME fraud. To combat fraud, the agency has, with the assistance of lawmakers via legislation, mandated accreditation, surety bonds, and implemented a competitive bidding program.
So what's the solution that isn't a solution? Competitive bidding.
The industry has been fighting a competitive bid for many years. In the late 90s it fought the bid demonstrations in Florida and Texas, and in early 2000 it fought a bid program until the industry lost that fight when the bid was mandated in MMA 2003.
Here's the unfortunate truth: There was and still is fraud in DME. It might be more difficult to commit fraud these days, but it's still very much around. I don't know about you, but as a taxpayer, I resent being robbed. We all should. Will competitive bidding eliminate a lot of fraudulent providers? Sure it will. But it will also eliminate a lot of ethical ones, and that's cause for concern.
Enter the Heroes of the Story
The unsung heroes of our story are the organizations that have tried very hard for many years to preach ethics and unity to DMEs across the nation, delivering a consistent message, providing information, education, and leading grassroots efforts to make DME a better, more honest industry.
I'm talking about organizations that have been around and working hard for the long haul; I'm talking about associations like MAMES, MESA, NAMPS, NCAMES, NEMED, VADMEC, and a (very) few other long-established entities.
These groups have worked very hard to engage DME providers in their respective areas. And if they haven't been as successful as they would like, the fault is in the DMEs who haven't actively supported their efforts.
Of late there have been new organizations springing up, undermining the existing organizations and splintering an industry that's weak and vulnerable largely in part because of its own apathy (and laziness). Where were these people before the passage of MMA 2003? It's all well and good to be an activist now, but it's a general truism that it's easier to prevent a thing than to undo it. Yet here they are now, filing lawsuits, hiring lobbyists, and trying to make it appear as though their intervention is going to save the industry.
It's an unfortunate turn of events.
No lawsuit filed against competitive bidding has ever been successful. A lot of money has been spent on fruitless litigation; it hasn't proved to be a sound investment.
Then there are the various pieces of legislation introduced to delay the bid process. This worked a few years ago (you all remember the doc fix, right?), and might again if a Senator can be found to introduce a companion bill (no luck yet after months of searching). Nothing new or original here, and a delay doesn't make competitive bidding go away.
I've observed an unfortunate trend with these new organizations, and it's that they seem to try to get maximum exposure at the expense of the existing associations with whom they're competing (and make no mistake: they're competing for dues dollars). They allege that they do and accomplish what their competitors do not, though their "leaders" aren't very familiar with the established organizations, and so aren't really in a position to know if what they're saying is truth (I sometimes suspect that that isn't an important detail).
And because we live in a world where political correctness is extreme, and because no one is willing to court controversy, the long-established organizations continue to quietly do what they do so well without crowing about every step they take and without denigrating the new arrivals.
If the long-established organizations had had the active support of the johnny-come-latelys before MMA 2003, things would probably be different for the DME industry today. It's obvious that unity is needed. This is virtually impossible to achieve, however, when the national organizations are embracing anyone who comes along on the off chance of a miracle, thereby making themselves look good because they "supported" the newcomers. What the national organizations appear to be ignoring is that even if this isn't their motivation, perception becomes reality, and the already-low industry morale drops even more.
It's time for the established organizations to rethink their strategies, alliances, and approaches to the problem that is competitive bidding, because the industry can't afford to be without them; they do the lion's share of the work. They don't spend their time trying to hog glory; they spend their time trying to get the job done. This is why they're the heroes of this story.
I'll give a brief primer for those unfamiliar with DME.
The Introduction
Most DMEs bill Medicare for products needed by and delivered to the program's beneficiaries. The DME doesn't name the prices for the products, Medicare does via its fee schedule. That's an important statement that Joe Average citizen often doesn't know. If a DME is willing to accept the Medicare reimbursement rate, then the DME can bill the program for reimbursement. Yes that's an oversimplification, because DMEs must meet specific criteria to be accepted providers, but the important thing here is that DMEs have no control over what Medicare will or will not pay.
The fee schedule has seen many changes over the years. In the beginning, DMEs did name their own prices for products, and as a result Medicare over-paid. When the Medicare program finally caught on to over-paying, it introduced the fee schedule. Reimbursements have been cut many times since its introduction as CMS has caught on to what things really cost DMEs, which in turn has cut into profits.
The 2010 budget for Medicare was proposed at $453 billion which is a 6.5 percent increase from 2009. Medicaid was to be funded at $290 billion in 2010, up 12 percent from 2009.
Some of the claims that are submitted to Medicare are, unfortunately, fraudulent. I'm not talking about errors made by billers, which CMS seems to lump in with fraud statistics. I'm talking about DMEs who submit claims for products not actually provided to beneficiaries and other "creative" billing strategies that benefit no one but the provider doing the billing. And though DME costs for Medicare are a tiny fraction of the agency's budget, the agency claims that DME fraud is a huge issue (to the tune of $700 million in improper payments).
The Solution That Isn't a Solution
Medicare has made a big deal, in the press and with Congress, about DME fraud. To combat fraud, the agency has, with the assistance of lawmakers via legislation, mandated accreditation, surety bonds, and implemented a competitive bidding program.
So what's the solution that isn't a solution? Competitive bidding.
The industry has been fighting a competitive bid for many years. In the late 90s it fought the bid demonstrations in Florida and Texas, and in early 2000 it fought a bid program until the industry lost that fight when the bid was mandated in MMA 2003.
Here's the unfortunate truth: There was and still is fraud in DME. It might be more difficult to commit fraud these days, but it's still very much around. I don't know about you, but as a taxpayer, I resent being robbed. We all should. Will competitive bidding eliminate a lot of fraudulent providers? Sure it will. But it will also eliminate a lot of ethical ones, and that's cause for concern.
Enter the Heroes of the Story
The unsung heroes of our story are the organizations that have tried very hard for many years to preach ethics and unity to DMEs across the nation, delivering a consistent message, providing information, education, and leading grassroots efforts to make DME a better, more honest industry.
I'm talking about organizations that have been around and working hard for the long haul; I'm talking about associations like MAMES, MESA, NAMPS, NCAMES, NEMED, VADMEC, and a (very) few other long-established entities.
These groups have worked very hard to engage DME providers in their respective areas. And if they haven't been as successful as they would like, the fault is in the DMEs who haven't actively supported their efforts.
Of late there have been new organizations springing up, undermining the existing organizations and splintering an industry that's weak and vulnerable largely in part because of its own apathy (and laziness). Where were these people before the passage of MMA 2003? It's all well and good to be an activist now, but it's a general truism that it's easier to prevent a thing than to undo it. Yet here they are now, filing lawsuits, hiring lobbyists, and trying to make it appear as though their intervention is going to save the industry.
It's an unfortunate turn of events.
No lawsuit filed against competitive bidding has ever been successful. A lot of money has been spent on fruitless litigation; it hasn't proved to be a sound investment.
Then there are the various pieces of legislation introduced to delay the bid process. This worked a few years ago (you all remember the doc fix, right?), and might again if a Senator can be found to introduce a companion bill (no luck yet after months of searching). Nothing new or original here, and a delay doesn't make competitive bidding go away.
I've observed an unfortunate trend with these new organizations, and it's that they seem to try to get maximum exposure at the expense of the existing associations with whom they're competing (and make no mistake: they're competing for dues dollars). They allege that they do and accomplish what their competitors do not, though their "leaders" aren't very familiar with the established organizations, and so aren't really in a position to know if what they're saying is truth (I sometimes suspect that that isn't an important detail).
And because we live in a world where political correctness is extreme, and because no one is willing to court controversy, the long-established organizations continue to quietly do what they do so well without crowing about every step they take and without denigrating the new arrivals.
If the long-established organizations had had the active support of the johnny-come-latelys before MMA 2003, things would probably be different for the DME industry today. It's obvious that unity is needed. This is virtually impossible to achieve, however, when the national organizations are embracing anyone who comes along on the off chance of a miracle, thereby making themselves look good because they "supported" the newcomers. What the national organizations appear to be ignoring is that even if this isn't their motivation, perception becomes reality, and the already-low industry morale drops even more.
It's time for the established organizations to rethink their strategies, alliances, and approaches to the problem that is competitive bidding, because the industry can't afford to be without them; they do the lion's share of the work. They don't spend their time trying to hog glory; they spend their time trying to get the job done. This is why they're the heroes of this story.
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