The whole object of education is to develop the mind. The mind should be a thing that works.
Sherwood Anderson
Education seems to be in America the only commodity of which the customer tries to get as little he can for his money.
Max L. Forman
They say that we are better educated than our parents' generation. What they mean is that we go to school longer. They are not the same thing.
Douglas Yates
Our schools have been progressively "dumbed down" for many years. Instead of expecting those behind to make an effort and reach up, we make things easier for them so they don't get any complexes about themselves. In the process, we create ignorance, encourage stupidity, and reward laziness.
Our expectations get lower and lower with every generation.
I was lucky to have gone to school in an excellent system at a time when students were expected to perform and faced consequences if they didn't. It was right before the bleeding hearts managed to get control of (and ruin) the system; if you failed a grade you got held back. These days failing students are passed for social reasons, and they walk away from the system as ignorant as they were when the entered it.
It's a sorry state of affairs that needs to be fixed.
There are those out there who went through a more rigorous educational system than exists today, and seem to have slept through it. I owe my ability to communicate well to my school days, and there are contemporaries (or near-contemporaries) of mine writing things that are so bad I'm almost in shock when I read them. I've complained before about the barely literate ramblings of some people; it's happened again (at least twice in a one-week period), and I simply can't stop myself from directly commenting and correcting.
There is nothing more frightful than ignorance in action.
Johann Wolfgang von Goethe
As I've said before, I get a lot sent to me by readers of this blog, and I appreciate it more than you know. Some of it keeps me informed, some of it puzzles me, some of it makes me angry at the state of the industry, and some of it makes me cry with laughter (which isn't always a good thing, as you're about to see).
How many times, readers, have I grumbled about the sub-literate stuff coming out of TAHCS? I know that some of their board members read this blog; that they don't respond is something that I prefer to interpret as a sign that they have a hair more sense than Rob Brant (whose response to one of my posts ended up being more grist for my mill and he really should have known better).
The first recent TAHCS item forwarded to me was an announcement about their upcoming conference, something they proclaim is "A must attend Event" in the headline that should have been "A Must-Attend Event." The inconsistent capitalization and missing punctuation warned me, but I read it anyhow.
They start out with "TACHS Sponsors" in bold, but list no one. Interesting. They tell us that it's "October 18th in Dallas at the Crown Plaza Hotel" but fail to end that sentence with a period. They also failed to spell the name of the hotel correctly. Brilliant.
It continues with this:
"The latest LoneStar Education event will incorporate up to date news from Washington and Austin regarding Medicare and Medicaid, Audits Updates, political insight, billing information, power wheelchair changes and much more.
The day long event, which includes lunch, will host some of America's top speakers on issues facing Medical equipment providers today.
We invite you to attend.
Dallas, Texas at the Crown Plaza Hotel on I-35.
Do not wait!
Do not miss this opportunity, and for such a great price, $99 for the day, including lunch."
Here's what it probably should have said:
The latest LoneStar Education event will incorporate up-to-date news from Washington D.C. about Medicare and from Austin about Texas Medicaid, an update on audits, political insight, billing information, power wheelchair changes, and much more.
This day-long event, which includes lunch, will host some of America's top speakers on issues facing medical equipment providers today.
Don't miss this opportunity, which at $99, includes lunch.
It might sound like a bargain, but I've had enough hotel food to know better than to be excited about lunch. Here's something else that troubles me: Nowhere in that announcement did they identify who these "top speakers" are. They want you to pay $99.00 without telling you who's speaking? Their idea of "top speakers" and my idea of "top speakers" are almost guaranteed to be poles apart.
TAHCS is going to give an update on what's going on with Texas Medicaid? That should be very informative, considering the fact that they didn't seem to show up for the MCAC meeting held in Austin on September 9th.
Yes, they were present at the competitive bidding hearings in D.C. last week, and made sure that everyone knew they were there, but they didn't do anything. Being seen is not necessarily evidence of being useful.
Considering the fact that TAHCS touts itself as the association for DMEs in Texas, they're offering almost nothing in leadership (or action) on key state issues. The presence of TAHCS in D.C. was a typical (and gratuitous) "look at us we're here" move; we should all be used to those by now. But not participating in the MCAC meeting in Austin when a potentially devastating procurement initiative looms?
And they're going to give people an update on it? They can't be serious.
The conference-announcement mail ends with this gem (the TACHS text is in regular face, and my comments are in italics within parenthesis):
"Dear Medical Equipment Provider,
You know well that there are still many threats to our industry, (colon here please, not a comma) Medicare's competitive bidding, audits from RAC, ZPIC and CERT, Medicaid Audits, oxygen caps, mobility payments, even PECOS and now our State's budget crisis threatens our payments (is there a reason they can't capitalize consistently and correctly?).
In order (delete "In order") to better control our destiny (destinies, guys; you're talking about more than one here) as businesses and as an industry, we need to be educated (a truer thought has never been expressed; they do need to be educated) and organized. To increase awareness, education, and industry unanimity (considering the TAHCS attitude toward MESA, it's my firm opinion that this organization should be the very last one to attempt to claim to promote industry unanimity; that's so hypocritical it's ridiculous), we are hosting once again hosting (do you need to use the word "hosting" twice in this sentence?) the LONESTAR HME Conference.
This event, sponsored by the Texas Alliance of Home Care Services (TAHCS) (you're missing a comma here) will provide you (you're missing the word "with" here) important information on how to make your business stronger and more secure.
(No one has information on how to make a business stronger and more secure if one's business is threatened by procurement programs and initiatives; there is no magic pill for what ails the industry.)
Once again the LoneStar HME Conference will be held at the Dallas Crown Plaza Market Center Hotel. This one-day event will bring together top professionals in various fields who will present topics including, but not limited to, the following:
* Competitive Bidding
* Medicare's Latest Changes
* ZPIC/RAC Audits
* Governmental Affairs Update
* DME Manufacturer/Supplier Lawsuits
* Texas Legislative Update in Health Care
* Effective Lobbying of HR 3790
* Choice of Business Entity for DME Supplies
* Proactive Chart Documentation"
Their list of topics could be covered in half of a day.
I was actually prepared to overlook their conference announcement, but I got the mail below forwarded to me today, and aside from how badly written it is, I took issue with some of what was said in it. Again, the TACHS text is in regular face, and my comments are in italics within parenthesis:
The situation regarding Competitive Bidding is clearly unviable (considering the fact that the program hasn't been implemented, it's impossible to say that something doesn't have a chance of success with any accuracy). Over the past year, and confirmed in the Energy and Commerce Hearings last week, Congress recognizes that the program was improperly thought out, poorly executed and will likely be a complete disaster for our HME businesses, and patients and Medicare itself. (Put any spin on the hearings last week that you like, but if Congress recognizes that the program is likely to be a disaster, why aren't they putting a stop to it?)
We know we will win and repeal the program, the question is when?. (Will you win before or after you learn to use the English language and punctuation properly?)
Congress is dragging its feet on both sides of the isle and on both sides of the capital dome. (Why are they dragging their feet if, as you insist, they've confirmed that competitive bidding is a bad thing?) Congress is reluctant to move any legislation in this political environment of looming elections. (Looming elections are now a political environment?) A passed bill can give one side credit (you mean it can give one side more political advantage than another) over another, or can create a vehicle for an opponent to create a new opposition piece prior to the November vote. (This is elementary politics. Everyone knows this.)
The result is that our federal legislature is at a stand still (put a hyphen between those two words), doing so little work it is hard to prove they are even in business. (Your expert activism hasn't fixed this yet?)
Our repeal bill is no exception to this scenario. HR 3790 is supported by the vast majority of House members (255 co-sponsors is barely half; it certainly isn't a "vast majority") and there is a definite base of support in the Senate (There's so much support in the Senate that you can't even find someone to introduce a companion bill, let alone get majority sponsorship for it.), but no one in Washington can or will guarantee the bill's passage prior to recess. We will utilize those contacts and supporters, along with other information and challenges raised in the different committee hearings, to have the bill attached to a must pass (put a hyphen between those two words) bill in November. (If the industry has as much support as you're implying, this shouldn't be necessary. Even so, you're going to face companion-bill issues, so this tactic might just backfire on the industry.)
After the elections, no matter the outcome, Congress will come back in session, a "lame duck" session, to finish unfinished business before Christmas, such as passing the "Doc Fix" bill. That or other legislation can serve as the tool to which we attach HR 3790 to gain passage and repeal the program prior to the implementation of Round 1. With the energy of our efforts, our government contacts and the information we raise, we can be successful at this. (You're doing nothing and saying nothing that hasn't been done and said before, and implementation of round one is practically around the corner.)
The worst case (place a hyphen between those two words) scenario is that Round 1 will be implemented for a few weeks or months. The problems with the program that we predicted will be revealed and Congress will be forced to repeal it. One way or the other we will win this fight, but the question is still when? (If you think that the "problems" you've "predicted" will reveal themselves within a few weeks or months, I have a bridge I'd like to sell to you. I'm for optimism, but I'd like a dose of realism included.)
Because we cannot be assured of the timing, it is imperative that everyone ready their company and patients for a change if it comes after January 1, 2010 (you mean 2011, right?). Grandfathering will allow companies to stay in business (at the new rates,) sub contracting (I give up on TAHCS and hyphens) is an option, working with Medicaid and insurance companies offer options and for some, straight retail is effective. No matter your plan of action to preserve your business, make it.
One great resource may be attending state association meetings and education events to learn insight that can help you hang on until victory is achieved. (I'm told that MESA does two fabulous events each year, both of which are held in Texas.)
Know that we are doing all we can, KNOW THAT WE WILL WIN.
We as an industry cannot stop in our efforts; phone calls, emails, faxes, meetings with congress people etc. All this needs to take place to ready our elected officials to support us in the "lame duck" session and beyond. We cannot lose our focus, our energy nor our commitment to our businesses. We advocate readiness.
We will win this battle and revel in success as will save Access to Care for 40 million Medicare beneficiaries while preserving the most cost effective industry in history....Home Care!
Ugh.
Did I point out all of there errors? No. There are just too many to name and correct, and just so many hours in the day.
For or Against?
I'm for finding a workable solution that serves the interests of all; yes, even those of CMS.
But I'm against presenting the situation the way TAHCS does. I have no doubt that the board of TAHCS and their (few) members really want to do away with competitive bidding. What I object to are the methods they employ and the sub-literate (and sub-standard) presentation. I know that I take someone far more seriously who is polished and well-spoken. And, if someone is presuming to inform, educate, and represent me and my interests with legislators, I expect them to communicate like professional adults (not send things out that make me cringe).
As is the case in so many industries and in much of life, image is everything. If you look and sound credible, you're more likely to be listened to and believed.
It's not okay to come across as ignorant. And TAHCS, your ignorance is showing (still).
Wednesday, September 22, 2010
Monday, September 20, 2010
You Get What You Pay For
Cliches can be trite or annoying (or trite and annoying). There are those who think that cliche = truism, on the grounds that if something is said by so many so often, it must be true. I take very little at face value, and to be on the safe side, I always assume that if a lot of people are saying something, they're all wrong until proven otherwise to my satisfaction. A negative stance? Perhaps. But it's amazing -- and frightening -- how often I'm actually right.
I'm not one of the flock; I do my own thinking. It may make people unhappy with me, but the truth is that that doesn't really concern me. I'm the one who has to live in my skin, and I'm the one who has to live with what I see in the mirror. As long as I obey most of the rules of society, I feel free to set and live up to my own standards.
There's one cliche, however, that I know is a truism, and that's the title of this blog: You Get What You Pay For.
I'm talking about that cliche being appropriate for the things in life that matter, not about cheaper paper towels or buying a name-brand can of green beans versus the house brand.
I'm talking about staffing your businesses.
Too often minimum wage means minimum effort from your employee. Yet these are the very people who make the biggest impressions on your customers.
Hello, May I Help You?
I can't tell you the number of times I've called providers, only to be confronted with receptionists who are rude, disinterested, or (in some cases and) impatient.
"XYZ Medical Supplies, how may I direct your call?"
"I'm not sure. I need to talk to someone about X product."
And then there's dead silence (or awful music or an even worse voice loop that tells me about the company), because the receptionist has either put me on hold without telling me, or has transferred me without telling me who can best help me. A little information and some politeness would have been really nice. But that rarely happens. I don't want a long conversation, but I would like to come away with a much better impression.
Your receptionist is most often the first impression your company gives. Yes, we all have bad days, and it can be difficult to leave that at home, but it doesn't belong in your business and on your phone.
Here's another cliche for you: You never get a second chance to make a first impression. Yes, you can smooth over ruffled feathers with an apology when your receptionist has been rude. My point is that you should hire a professional to answer your phone so those apologies don't have to be made and so your company doesn't make a bad impression when she (or he) answers the phone.
Most receptionists are paid minimum wage (or close to it). In most cases, you're getting what you pay for. Hiring a better quality of employee may cost more, but the investment will pay off in the long run.
Here's another thing that makes a bad impression: Automated answering systems. They're awful. An automated system says to me that you can't be bothered to answer your own phone; in a lot of cases the option that I want or need isn't offered, and getting to an "operator" is almost impossible. On the occasions I am able to get a person with a pulse on the other end of the line, that person is rude.
These systems may seem ideal to business owners, but most people confronted with them hate them. You may, after the initial investment in the system, save money because you're not paying someone to sit and answer your phone, but the system isn't doing much for your image.
When someone calls your company, you want that person to feel good about it. I know that if I have a pleasant experience with a company, I tell others about it. We all know how important word-of-mouth advertising is, don't we?
Where Do You Want This?
So you have a new client, you've done all the necessary paperwork, and it's time to deliver the item(s).
Are you putting your best foot forward with your delivery person? Probably not.
DMEs typically pay the minimum amount they can get away with for delivery staff. They're only delivery guys, right?
Wrong!
Your customers may never meet any other person associated with your company. They might talk with other staff on the phone, but the only individual with whom they'll have in-person contact is your delivery guy.
What kind of impression are you making if you send a guy who barely speaks the language, or who looks intimidating, or who could stand to have taken a shower? I know that in some areas having a delivery driver who is bi-lingual is an advantage, but I don't consider a man who is barely functional in English to be bi-lingual. Frustrating and irritating yes, bi-lingual no. I accept that there are other languages spoken in this country, but if you're sending drivers out who can't communicate effectively in English, you're offending your American-born clients (you're also making it very difficult for them to understand your driver).
I know that when I go into a store and can't find anyone who speaks English, I take my commerce elsewhere.
I'm sure some of my readers will be offended because I'm rather militant about "foreigners" speaking English. I'm not sorry about it. Not at all.
I once saw a bumper sticker that said "Welcome to America Now Speak English." Several generations ago some of my ancestors came to this country, and didn't speak English. They did, however, make it their business to learn it and to use it as their working language.
Did they continue to use their native languages? Yes, among family and close friends. They wouldn't have dreamed of expecting the majority of the population (the majority being those who spoke and functioned in English) to accommodate them, the minority. Was it easy for them, as adults, to learn English? Of course not. But they did it and they did it well because they made a genuine effort.
I acknowledge that there are those out there who have no talent for languages. That's a true shame, but I'd rather not have them inflicted on me because their language deficiencies make them cheap labor. I suspect that many people feel the same way I do, but it's not politically correct to say so. People stay silent for fear of being vilified for expressing an opinion that others may jump on as discriminatory or xenophobic.
I am neither discriminatory nor am I xenophobic. What I am is tired of extremely poor service and abominable English.
There is another aspect to the language issue. What if your delivery guy's inability to communicate effectively has a negative impact on your customers? Are there potential liability issues involved?
Nothing inspires confidence and warmth like an individual who presents himself well, communicates clearly, and who is knowledgeable. If I'm a customer and I have questions about a product being delivered, I'd like to be welcoming someone into my home who can understand, and in some cases, answer my questions clearly and thoroughly.
Your delivery drivers, if chosen well and paid well, can serve many purposes; they're out there in front of your patients all the time. How many of your customers have met the owners and managers of your DME?
Say What?
I was once in a group of DME owners, and the conversation turned to delivery staff. The consensus was that hiring the guys at minimum wage was the way to go, even though the turnover rate was high. They're only delivery guys, after all, and anyone can do that job.
Excuse me?
You have time and money invested in training every single employee. Each time a member of staff leaves, you have to spend time and money finding a replacement, and spend time and money training the replacement.
Minimum wage = temporary employee.
Paying a delivery guy or a receptionist minimum wage might seem to be a good way to keep operating costs down, but the truth of the matter is that you're spending far more on those positions in the long run. If you look at those members of staff as the key ones they really are, then you'll see that a larger investment in them -- the people who are the public faces of your company -- will benefit all concerned.
I'm not one of the flock; I do my own thinking. It may make people unhappy with me, but the truth is that that doesn't really concern me. I'm the one who has to live in my skin, and I'm the one who has to live with what I see in the mirror. As long as I obey most of the rules of society, I feel free to set and live up to my own standards.
There's one cliche, however, that I know is a truism, and that's the title of this blog: You Get What You Pay For.
I'm talking about that cliche being appropriate for the things in life that matter, not about cheaper paper towels or buying a name-brand can of green beans versus the house brand.
I'm talking about staffing your businesses.
Too often minimum wage means minimum effort from your employee. Yet these are the very people who make the biggest impressions on your customers.
Hello, May I Help You?
I can't tell you the number of times I've called providers, only to be confronted with receptionists who are rude, disinterested, or (in some cases and) impatient.
"XYZ Medical Supplies, how may I direct your call?"
"I'm not sure. I need to talk to someone about X product."
And then there's dead silence (or awful music or an even worse voice loop that tells me about the company), because the receptionist has either put me on hold without telling me, or has transferred me without telling me who can best help me. A little information and some politeness would have been really nice. But that rarely happens. I don't want a long conversation, but I would like to come away with a much better impression.
Your receptionist is most often the first impression your company gives. Yes, we all have bad days, and it can be difficult to leave that at home, but it doesn't belong in your business and on your phone.
Here's another cliche for you: You never get a second chance to make a first impression. Yes, you can smooth over ruffled feathers with an apology when your receptionist has been rude. My point is that you should hire a professional to answer your phone so those apologies don't have to be made and so your company doesn't make a bad impression when she (or he) answers the phone.
Most receptionists are paid minimum wage (or close to it). In most cases, you're getting what you pay for. Hiring a better quality of employee may cost more, but the investment will pay off in the long run.
Here's another thing that makes a bad impression: Automated answering systems. They're awful. An automated system says to me that you can't be bothered to answer your own phone; in a lot of cases the option that I want or need isn't offered, and getting to an "operator" is almost impossible. On the occasions I am able to get a person with a pulse on the other end of the line, that person is rude.
These systems may seem ideal to business owners, but most people confronted with them hate them. You may, after the initial investment in the system, save money because you're not paying someone to sit and answer your phone, but the system isn't doing much for your image.
When someone calls your company, you want that person to feel good about it. I know that if I have a pleasant experience with a company, I tell others about it. We all know how important word-of-mouth advertising is, don't we?
Where Do You Want This?
So you have a new client, you've done all the necessary paperwork, and it's time to deliver the item(s).
Are you putting your best foot forward with your delivery person? Probably not.
DMEs typically pay the minimum amount they can get away with for delivery staff. They're only delivery guys, right?
Wrong!
Your customers may never meet any other person associated with your company. They might talk with other staff on the phone, but the only individual with whom they'll have in-person contact is your delivery guy.
What kind of impression are you making if you send a guy who barely speaks the language, or who looks intimidating, or who could stand to have taken a shower? I know that in some areas having a delivery driver who is bi-lingual is an advantage, but I don't consider a man who is barely functional in English to be bi-lingual. Frustrating and irritating yes, bi-lingual no. I accept that there are other languages spoken in this country, but if you're sending drivers out who can't communicate effectively in English, you're offending your American-born clients (you're also making it very difficult for them to understand your driver).
I know that when I go into a store and can't find anyone who speaks English, I take my commerce elsewhere.
I'm sure some of my readers will be offended because I'm rather militant about "foreigners" speaking English. I'm not sorry about it. Not at all.
I once saw a bumper sticker that said "Welcome to America Now Speak English." Several generations ago some of my ancestors came to this country, and didn't speak English. They did, however, make it their business to learn it and to use it as their working language.
Did they continue to use their native languages? Yes, among family and close friends. They wouldn't have dreamed of expecting the majority of the population (the majority being those who spoke and functioned in English) to accommodate them, the minority. Was it easy for them, as adults, to learn English? Of course not. But they did it and they did it well because they made a genuine effort.
I acknowledge that there are those out there who have no talent for languages. That's a true shame, but I'd rather not have them inflicted on me because their language deficiencies make them cheap labor. I suspect that many people feel the same way I do, but it's not politically correct to say so. People stay silent for fear of being vilified for expressing an opinion that others may jump on as discriminatory or xenophobic.
I am neither discriminatory nor am I xenophobic. What I am is tired of extremely poor service and abominable English.
There is another aspect to the language issue. What if your delivery guy's inability to communicate effectively has a negative impact on your customers? Are there potential liability issues involved?
Nothing inspires confidence and warmth like an individual who presents himself well, communicates clearly, and who is knowledgeable. If I'm a customer and I have questions about a product being delivered, I'd like to be welcoming someone into my home who can understand, and in some cases, answer my questions clearly and thoroughly.
Your delivery drivers, if chosen well and paid well, can serve many purposes; they're out there in front of your patients all the time. How many of your customers have met the owners and managers of your DME?
Say What?
I was once in a group of DME owners, and the conversation turned to delivery staff. The consensus was that hiring the guys at minimum wage was the way to go, even though the turnover rate was high. They're only delivery guys, after all, and anyone can do that job.
Excuse me?
You have time and money invested in training every single employee. Each time a member of staff leaves, you have to spend time and money finding a replacement, and spend time and money training the replacement.
Minimum wage = temporary employee.
Paying a delivery guy or a receptionist minimum wage might seem to be a good way to keep operating costs down, but the truth of the matter is that you're spending far more on those positions in the long run. If you look at those members of staff as the key ones they really are, then you'll see that a larger investment in them -- the people who are the public faces of your company -- will benefit all concerned.
Friday, September 10, 2010
This Just In
I don't like to blog every day because some of what I say can take a while to digest. Too much of a good thing can be a bad thing; if you don't believe me, go eat a whole cheesecake by yourself in one sitting. Cheesecake is wonderful stuff, but not in large quantities.
I feel the same way about my blog as I do cheesecake. It's wonderful stuff, but not in too-frequent doses.
Yesterday I discussed a proposed competitive procurement of incontinence supplies in Texas. There was a meeting held in Austin yesterday of the Texas HHSC's MCAC (which is the Medical Care Advisory Committee), and the proposed initiative was on the agenda.
MESA was there, and has sent an update to its Texas members; it was kindly forwarded to me (many thanks to the people who sent it to me!). It says:
"Thanks in large part to testimony from concerned providers-many of whom were MESA members (particularly John Calhoun, Owner/President of Houston-based Medco Medical Supply, and Chris Yule, President of Travis Medical, in Austin), and with a little help from your Executive Director, through pre-submitted written comments and oral testimony, the Texas MCAC voted unanimously yesterday to not approve the rule submitted to institute competitive procurement of incontinence supplies. The statistics provided through the surveys that many of you sent us were also very helpful.
The MCAC further recommended that the Texas Comptroller Public Accounts (TCPA) (the agency responsible for the initiative) form a work group of TEXAS providers and other interested parties, to discuss reduction of fraud and abuse, other ways to cut costs and/or an "acceptable" version of competitive procurement-one that might include out-of-state providers, but would not be single-source, and would ensure that more stakeholders are included.
The MCAC also asked the TCPA to provide more accurate figures on fraud and abuse, as well as documentation as to cost involved to implement a competitive procurement program, and a better analysis of how patients would be assured of access to care and quality products.
This Rule may still come before the Texas HHSC in October, or resurface in some other form at some future date, despite the MCAC's ruling, but at the very least, we feel it lost some momentum yesterday. We will continue to monitor the matter and update you as news comes in."
This is really good news for Texas incontinence suppliers. The coordinated efforts of those present appear to have paid off. Even if the procurement threat hasn't disappeared entirely, the initiative has suffered a set-back, and that's more than anyone could have hoped for considering the very short notice (and very small amount of time they had to pull together).
Nosy Parker
I admit that I'm nosy; I have to be to write this blog. If you're a regular reader and are at all perceptive, you have to know what one of my discreet questions was when digging for more information on this particular issue.
We know from MESA's update to its members that the association was represented by its Executive Director, and that there were MESA members present and participating. The last place I'd expect to see any mention of TAHCS is in a MESA release (for good reason!), so my inquiring mind wanted to know if TAHCS was there, if TAHCS participated, and if TAHCS was part of the process.
All appearances are that TAHCS, the group that calls itself the state association serving Texas, was not there. No one identified as a TAHCS representative testified or made any public statement for the record.
MESA serves five states; TAHCS claims to serve one (and has made uninformed, misleading and disparaging remarks about what MESA does and does not do). MESA managed to be there to serve its Texas members very well and very publicly.
Who is the association serving Texas providers? I'll leave my readers to decide that.
From the Southwest to the Northeast
I invited readers in my last blog to tell me about any other state issues they'd like to see highlighted, and someone took me up on my invitation.
Competitive procurement is moving into the private sector if the RFI (request for inquiry) sprung on BCBS participating suppliers in Massachusetts is any indication. The similarities between the Texas incontinence initiative and the RFI in MA are, to my informant, pretty clear; the problem with this type of scenario is that a private insurance company has more autonomy than a state-run, government-funded program like Medicaid.
Kudos to NEMED for its hard work and dedication; my informant couldn't say enough about how supportive and how active NEMED has been in that struggle (the efforts of those in the fight have been rewarded with a delay in the process).
If I can dig up added details on this issue I will do so and discuss it further here. We can all learn from the examples set and be inspired by NEMED and MESA; these stories demonstrate how active participation and professional leadership can make a difference and why you should be supporting your state (or regional) association (if it's a useful one, of course).
I feel the same way about my blog as I do cheesecake. It's wonderful stuff, but not in too-frequent doses.
Yesterday I discussed a proposed competitive procurement of incontinence supplies in Texas. There was a meeting held in Austin yesterday of the Texas HHSC's MCAC (which is the Medical Care Advisory Committee), and the proposed initiative was on the agenda.
MESA was there, and has sent an update to its Texas members; it was kindly forwarded to me (many thanks to the people who sent it to me!). It says:
"Thanks in large part to testimony from concerned providers-many of whom were MESA members (particularly John Calhoun, Owner/President of Houston-based Medco Medical Supply, and Chris Yule, President of Travis Medical, in Austin), and with a little help from your Executive Director, through pre-submitted written comments and oral testimony, the Texas MCAC voted unanimously yesterday to not approve the rule submitted to institute competitive procurement of incontinence supplies. The statistics provided through the surveys that many of you sent us were also very helpful.
The MCAC further recommended that the Texas Comptroller Public Accounts (TCPA) (the agency responsible for the initiative) form a work group of TEXAS providers and other interested parties, to discuss reduction of fraud and abuse, other ways to cut costs and/or an "acceptable" version of competitive procurement-one that might include out-of-state providers, but would not be single-source, and would ensure that more stakeholders are included.
The MCAC also asked the TCPA to provide more accurate figures on fraud and abuse, as well as documentation as to cost involved to implement a competitive procurement program, and a better analysis of how patients would be assured of access to care and quality products.
This Rule may still come before the Texas HHSC in October, or resurface in some other form at some future date, despite the MCAC's ruling, but at the very least, we feel it lost some momentum yesterday. We will continue to monitor the matter and update you as news comes in."
This is really good news for Texas incontinence suppliers. The coordinated efforts of those present appear to have paid off. Even if the procurement threat hasn't disappeared entirely, the initiative has suffered a set-back, and that's more than anyone could have hoped for considering the very short notice (and very small amount of time they had to pull together).
Nosy Parker
I admit that I'm nosy; I have to be to write this blog. If you're a regular reader and are at all perceptive, you have to know what one of my discreet questions was when digging for more information on this particular issue.
We know from MESA's update to its members that the association was represented by its Executive Director, and that there were MESA members present and participating. The last place I'd expect to see any mention of TAHCS is in a MESA release (for good reason!), so my inquiring mind wanted to know if TAHCS was there, if TAHCS participated, and if TAHCS was part of the process.
All appearances are that TAHCS, the group that calls itself the state association serving Texas, was not there. No one identified as a TAHCS representative testified or made any public statement for the record.
MESA serves five states; TAHCS claims to serve one (and has made uninformed, misleading and disparaging remarks about what MESA does and does not do). MESA managed to be there to serve its Texas members very well and very publicly.
Who is the association serving Texas providers? I'll leave my readers to decide that.
From the Southwest to the Northeast
I invited readers in my last blog to tell me about any other state issues they'd like to see highlighted, and someone took me up on my invitation.
Competitive procurement is moving into the private sector if the RFI (request for inquiry) sprung on BCBS participating suppliers in Massachusetts is any indication. The similarities between the Texas incontinence initiative and the RFI in MA are, to my informant, pretty clear; the problem with this type of scenario is that a private insurance company has more autonomy than a state-run, government-funded program like Medicaid.
Kudos to NEMED for its hard work and dedication; my informant couldn't say enough about how supportive and how active NEMED has been in that struggle (the efforts of those in the fight have been rewarded with a delay in the process).
If I can dig up added details on this issue I will do so and discuss it further here. We can all learn from the examples set and be inspired by NEMED and MESA; these stories demonstrate how active participation and professional leadership can make a difference and why you should be supporting your state (or regional) association (if it's a useful one, of course).
Thursday, September 9, 2010
Monkey See Monkey Do
The last several years has seen the Medicaid programs in several states following the lead of CMS when it comes to competitive bidding. Several states have tried; some have failed and some have succeeded. I only say "succeeded" in the sense that they managed to implement bids, not that the bids have been "good."
Some of these states have attempted or done single-source bids on incontinence supplies (in some cases ostomy and urological supplies have been included).
At the root of the problem in most cases are companies who hire lobbyists to approach the relevant state agencies and do what I call a dirty deal. The companies and the state agencies involved work out details in advance, and then the state goes through the motions of doing a bid with the "winner" already chosen.
This happened in Florida not once but twice; the then well-led FAMES defeated the greedy (and sneaky) company that was trying to put the screws to other providers by working behind the scenes with Florida Medicaid to eliminate competition by obtaining a single-provider contract with the state.
Michigan and Wisconsin have also endured similar fights, but ended up losing them.
Even though my own opinion is that the companies who attempt the maneuvers are slimy, the fact is that they're being proactive businessmen. Do they really care about the costs to the small businesses they're shutting out or the patients the small businesses serve? I don't think so. All they care about is monopolizing the market and maximizing their profits.
I view this as a cowardly tactic. If they're such great companies, let them knock out the competition by out-performing other businesses, not by buying a rigged competitive bid process.
The state agencies who participate in these pathetic deals are every bit as guilty as the greed motivated companies who approach the agencies. Agency staff are paid by the tax-payers, and when they work private deals that work against the interests of the businesses and patients, they should all be fired. I mean fired immediately.
That these agencies would do something like this as the expense of tax-paying citizens of the state is outrageous and unacceptable. They justify their dirty deals with claims of fraud, cost-savings, and that there are too many providers for them to manage well, but their fraud statistics are often misleading, cost-savings could be realized by tweaking a fee schedule that they control, and if they can't manage the number of providers in the system they need to make adjustments within.
The excuses are lame.
Is there fraud in DME? Certainly. We all know this. But it isn't fraud motivating these programs. It's stupidity on the side of the agencies and unmitigated greed on the side of the monopoly seekers.
There's a new front in this kind of battle, and that front is Texas. From what I'm able to gather, it isn't Texas Medicaid so much as it is the Texas bean counters driving this particular initiative (an incontinence bid), which makes this situation more ridiculous than most. Accountants in charge of health care? That's like ballet dancers being put in charge of the police.
The blasts that MESA and TAHCS have sent out about this have been forwarded to me; apparently some of my gentle readers want to keep me in the loop, and I do appreciate it. Thank you.
As usual, the TAHCS information is sub-literate, confused, and in some places, just plain wrong. That they publish as fact what can be so easily checked and proven in error is a mystery to me; it makes them look pretty darned silly (not that that's an unusual look for them, in my opinion).
I'm sure that TAHCS is doing something about the situation, but I'm also sure that MESA is working hard on this bid issue. I know some MESA members, and I'm told that MESA's efforts are in combination with several well-placed and respected lobbyists, and that the team is on top of things.
Between you and me, I'm waiting for TAHCS to send out a press release or two about how successful they are in dealing with this challenge (no doubt all by themselves), and how they are "there" for Texas providers.
That will make me laugh as hard as their ridiculousness at the MESA competitive bidding networking event did (see my last blog for details if you're not in on the joke), but I fully expect to see them take all credit for all achievement. It's how they roll, but I see it for what it is; I'll file it in my fiction section.
These Medicaid battles are very important for suppliers to participate in, even if you aren't a Medicaid provider. Why? You might at some point change your mind and want to be a Medicaid provider. The doors that close today are the ones you can't open if you want or need to tomorrow.
In other words, it's easier to prevent something than to undo it.
And there is a principle at stake here. These agencies work for you; you pay the taxes that provide an agency's staff with their jobs. They do what they do because they too often get away with it; if they aren't watched and called on their bad behavior, they're encouraged, and the cycle continues.
If you're in a state that's moving in a Medicaid bid direction, take advantage of the fact that it's an election year; use it to manipulate events and influence those seeking election.
Things can change. The problem is that changing things takes vigilance and consistent effort, and few people are willing to give most issues the attention required. You really can fight city hall, and it's time for those sitting on the sidelines to jump in.
If you're in a state with a Medicaid bid issue that hasn't been mentioned in today's blog, drop me a line if you'd like it highlighted.
Some of these states have attempted or done single-source bids on incontinence supplies (in some cases ostomy and urological supplies have been included).
At the root of the problem in most cases are companies who hire lobbyists to approach the relevant state agencies and do what I call a dirty deal. The companies and the state agencies involved work out details in advance, and then the state goes through the motions of doing a bid with the "winner" already chosen.
This happened in Florida not once but twice; the then well-led FAMES defeated the greedy (and sneaky) company that was trying to put the screws to other providers by working behind the scenes with Florida Medicaid to eliminate competition by obtaining a single-provider contract with the state.
Michigan and Wisconsin have also endured similar fights, but ended up losing them.
Even though my own opinion is that the companies who attempt the maneuvers are slimy, the fact is that they're being proactive businessmen. Do they really care about the costs to the small businesses they're shutting out or the patients the small businesses serve? I don't think so. All they care about is monopolizing the market and maximizing their profits.
I view this as a cowardly tactic. If they're such great companies, let them knock out the competition by out-performing other businesses, not by buying a rigged competitive bid process.
The state agencies who participate in these pathetic deals are every bit as guilty as the greed motivated companies who approach the agencies. Agency staff are paid by the tax-payers, and when they work private deals that work against the interests of the businesses and patients, they should all be fired. I mean fired immediately.
That these agencies would do something like this as the expense of tax-paying citizens of the state is outrageous and unacceptable. They justify their dirty deals with claims of fraud, cost-savings, and that there are too many providers for them to manage well, but their fraud statistics are often misleading, cost-savings could be realized by tweaking a fee schedule that they control, and if they can't manage the number of providers in the system they need to make adjustments within.
The excuses are lame.
Is there fraud in DME? Certainly. We all know this. But it isn't fraud motivating these programs. It's stupidity on the side of the agencies and unmitigated greed on the side of the monopoly seekers.
There's a new front in this kind of battle, and that front is Texas. From what I'm able to gather, it isn't Texas Medicaid so much as it is the Texas bean counters driving this particular initiative (an incontinence bid), which makes this situation more ridiculous than most. Accountants in charge of health care? That's like ballet dancers being put in charge of the police.
The blasts that MESA and TAHCS have sent out about this have been forwarded to me; apparently some of my gentle readers want to keep me in the loop, and I do appreciate it. Thank you.
As usual, the TAHCS information is sub-literate, confused, and in some places, just plain wrong. That they publish as fact what can be so easily checked and proven in error is a mystery to me; it makes them look pretty darned silly (not that that's an unusual look for them, in my opinion).
I'm sure that TAHCS is doing something about the situation, but I'm also sure that MESA is working hard on this bid issue. I know some MESA members, and I'm told that MESA's efforts are in combination with several well-placed and respected lobbyists, and that the team is on top of things.
Between you and me, I'm waiting for TAHCS to send out a press release or two about how successful they are in dealing with this challenge (no doubt all by themselves), and how they are "there" for Texas providers.
That will make me laugh as hard as their ridiculousness at the MESA competitive bidding networking event did (see my last blog for details if you're not in on the joke), but I fully expect to see them take all credit for all achievement. It's how they roll, but I see it for what it is; I'll file it in my fiction section.
These Medicaid battles are very important for suppliers to participate in, even if you aren't a Medicaid provider. Why? You might at some point change your mind and want to be a Medicaid provider. The doors that close today are the ones you can't open if you want or need to tomorrow.
In other words, it's easier to prevent something than to undo it.
And there is a principle at stake here. These agencies work for you; you pay the taxes that provide an agency's staff with their jobs. They do what they do because they too often get away with it; if they aren't watched and called on their bad behavior, they're encouraged, and the cycle continues.
If you're in a state that's moving in a Medicaid bid direction, take advantage of the fact that it's an election year; use it to manipulate events and influence those seeking election.
Things can change. The problem is that changing things takes vigilance and consistent effort, and few people are willing to give most issues the attention required. You really can fight city hall, and it's time for those sitting on the sidelines to jump in.
If you're in a state with a Medicaid bid issue that hasn't been mentioned in today's blog, drop me a line if you'd like it highlighted.
Thursday, September 2, 2010
The Tacky Award Goes To ...
There are some people you'll meet in life who will make you shake your head and wonder what they're thinking (or if they're thinking) when they do some of the things they do or say some of the things they say.
The last 20 or 25 years has been a time of decline in basic good manners, intelligence (how much more can we be dumbed down?), and common sense. True, common sense isn't so common these days; it seems to be a commodity in extremely short supply. Standards have slipped far too much, and the clueless seem to be everywhere.
Rebels Without a Clue
I'm a curious person. I'm lucky because I know a lot of people, and can get "scoop" in many areas. If you'll recall my promotion of the MESA CB networking event, you'll know that it was something I thought was a terrific idea. It was innovative and a real service to bid winners and potential subcontractors alike.
Considering Rob Brant's stated position on MESA (there's a previous blog dedicated to the comment he posted if you need to refresh your memory), and the regular bashing that TAHCS does to MESA, I find it very interesting and extremely amusing that TAHCS board members Dean Cheney and Barry Johnson showed up at the networking event last night (I'm told Barry brought his wife with him too).
That they would show their faces at a MESA event is one of the tackiest things I've heard of in a long time. If I wasn't laughing so hard at them I might be indignant.
Did Dean Cheney and Barry Johnson get in? I'm told they did not, which is exactly what they deserved. I've made my opinion of the practices of TAHCS very clear, and this is basically the icing on my cake. It perfectly illustrates the points I've made (past and present).
Was MESA supposed to cave to this ridiculous maneuver? Did Johnson and Cheney think that they'd bully their way into the event? Did they think that no one would dare to turn them away? Why would anyone go where they're so obviously not welcome (where they've made themselves so unwelcome)?
The first-ever STC Tacky Award goes to Dean Cheney and Barry Johnson and any other TAHCS devotee (few though they may be) who was there. Thank you guys; I appreciate the laugh, even as I'm shaking my head and wondering if you were thinking.
Wait! There's More!
We have a runner-up! Honorable mention goes to the VGM representative who was present, and who I'm told by witnesses was obnoxious, rude, and very disrespectful to MESA staff last night. Yes, he'd been in the bar drinking with the TAHCS outcasts, so it may be that he had too much liquid courage. But my informants, who overheard the person in question, were shocked that a VGM representative would shout his opinions for so many to hear (and equally shocked that he would presume to quote VGM leadership the way he did).
I'm not going to give the runner-up award to the VGM Group because I'm going to assume that they are unaware of the activities (and the tackiness) of their field representative. But his actions last night do them absolutely no credit, and it's something they should take a long, hard look at.
I hope my readers have found this to be as amusing and enlightening as I have; I enjoy light-hearted posts.
The last 20 or 25 years has been a time of decline in basic good manners, intelligence (how much more can we be dumbed down?), and common sense. True, common sense isn't so common these days; it seems to be a commodity in extremely short supply. Standards have slipped far too much, and the clueless seem to be everywhere.
Rebels Without a Clue
I'm a curious person. I'm lucky because I know a lot of people, and can get "scoop" in many areas. If you'll recall my promotion of the MESA CB networking event, you'll know that it was something I thought was a terrific idea. It was innovative and a real service to bid winners and potential subcontractors alike.
Considering Rob Brant's stated position on MESA (there's a previous blog dedicated to the comment he posted if you need to refresh your memory), and the regular bashing that TAHCS does to MESA, I find it very interesting and extremely amusing that TAHCS board members Dean Cheney and Barry Johnson showed up at the networking event last night (I'm told Barry brought his wife with him too).
That they would show their faces at a MESA event is one of the tackiest things I've heard of in a long time. If I wasn't laughing so hard at them I might be indignant.
Did Dean Cheney and Barry Johnson get in? I'm told they did not, which is exactly what they deserved. I've made my opinion of the practices of TAHCS very clear, and this is basically the icing on my cake. It perfectly illustrates the points I've made (past and present).
Was MESA supposed to cave to this ridiculous maneuver? Did Johnson and Cheney think that they'd bully their way into the event? Did they think that no one would dare to turn them away? Why would anyone go where they're so obviously not welcome (where they've made themselves so unwelcome)?
The first-ever STC Tacky Award goes to Dean Cheney and Barry Johnson and any other TAHCS devotee (few though they may be) who was there. Thank you guys; I appreciate the laugh, even as I'm shaking my head and wondering if you were thinking.
Wait! There's More!
We have a runner-up! Honorable mention goes to the VGM representative who was present, and who I'm told by witnesses was obnoxious, rude, and very disrespectful to MESA staff last night. Yes, he'd been in the bar drinking with the TAHCS outcasts, so it may be that he had too much liquid courage. But my informants, who overheard the person in question, were shocked that a VGM representative would shout his opinions for so many to hear (and equally shocked that he would presume to quote VGM leadership the way he did).
I'm not going to give the runner-up award to the VGM Group because I'm going to assume that they are unaware of the activities (and the tackiness) of their field representative. But his actions last night do them absolutely no credit, and it's something they should take a long, hard look at.
I hope my readers have found this to be as amusing and enlightening as I have; I enjoy light-hearted posts.
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