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.
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