Are You Being Served?

ser·vice [ súrvəss ]

1. work done for somebody else: work done by somebody for somebody else as a job, duty, punishment, or favor
2. helpful action: an action done to help somebody or as a favor to somebody
3. work for customers: work done for the customers of a store, restaurant, hotel, or similar establishment, often with regard to whether it pleases them or not

My last blog seems to have touched a nerve. Industry organizations and trade associations are all about service. They produce no tangible goods. The worth of an industry organization can be measured in the quality of service it gives to its members.

Controversy is only dreaded by the advocates of error. (Benjamin Rush)

A lot of what I say about the DME industry, its individual advocates, and its service organizations is controversial. I don't fear controversy, because I see it as a productive tool of change. I despise political correctness, because I view that as verbal tyranny. I've had people tell me that though they agree with something I've said, they're not going to do so publicly, lest they hurt or offend someone.

What's wrong with that? A lot. These people, instead of speaking their minds, are cowed into silently maintaining the status quo, even though they disagree with it.

Even if their silence hurts them in the long run.

Freedom of expression was granted to each American citizen by the founders of this country. That our society has become one where only a few have the guts to express themselves, often at great cost to others, is one of the saddest statements I can make.

Things won't change, readers, if you don't make them change. I've said it before and I'll say it again: You can say what's on your mind and be polite about it (if the situation warrants that kind of thoughtfulness). But you should never, ever, be afraid to say what you think because you fear being talked about or unpopular or because you fear reprisal.

Both pass quickly. Ask the Dixie Chicks, or anyone else who's been through a scandal. If they survived it, so will you. If things are a bit unpleasant for a while, hold your head up and be proud that you took steps toward effecting change. And don't for a minute allow anyone to make you think that you're in the wrong if you're a lone dissenting voice. If "they" are so right, why are things so wrong?

The first duty of a wise advocate is to convince his opponents that he understands their arguments, and sympathizes with their just feelings. (Samuel Taylor Coleridge)

The DME industry is packed with advocates. The problem is that some of them serve everyone badly (AAHomecare), and some of them clearly seem serve only their own interests (AMEPA, FAHCS and TAHCS).

No man should advocate a course in private that he's ashamed to admit in public. (George McGovern)

I got mail about my last blog, and in it a reader told me that AAHomecare's plan to seek an administrative delay to "adjust" competitive bidding was formulated and sprung on the state/regional associations with no consultation and no warning. I'm told that the plan was a "board action," and the states were asked to either agree with it or not agree with it (and if they didn't agree, they were asked for an alternative "practical" solution).

I've done some digging, and I've found that several of the state associations disagreed with AAHomecare; I'm told that at least one of them called for new staff at AAHomecare.

We need to find the courage to say NO to the things and people that are not serving us if we want to rediscover ourselves and live our lives with authenticity. (Barbara De Angelis)

AAHomecare's membership has been in steady decline for a decade. Though they claim to have a membership of 3,000 locations in all 50 states, I'm wondering how many actual members they have, and whether or not AAHomecare has many small, independent providers.

A leader is one who knows the way, goes the way, and shows the way. (John C. Maxwell)

I'm not saying that AAHomecare is alone in the failure to prevent and then to repeal competitive bidding. But though the industry gets a lot (too much) of hot air and posturing from AMEPA and their FAHCS/TAHCS off-shoots, AAHomecare is the organization that tells the DMEs that it is their "voice in Washington." AAHomecare tells its members that it is seen in Washington as the "credible representative of HME."

If this is the case, and I doubt it is, this is bad news for the industry. Why? Because the association wants an "administrative" delay so the program can be tweaked (again) and brought into line with what some economists had to say, which will then result in the industry accepting the program.

It is a bad plan that admits of no modification. (Publilius Syrus)

The current AAHomecare plan isn't a modification, it's pretty much a re-run. Did the first delay do any good? No. During that time, there was at least an effort to repeal competitive bidding. Now the goal is to change it so it's more palatable.

That's not much of a goal.

He that will not apply new remedies must expect new evils; for time is the greatest innovator. (Francis Bacon)

A new remedy isn't a drastically watered-down goal that amounts to giving up.

In times of rapid change, experience could be your worst enemy. (J. Paul Getty)

Despite the anger and disagreement of so many in the industry, AAHomecare appears to be moving ahead with its plan. I can only conclude that the association's board and its staff think that they know better than anyone else. History has not proven them right.

The worst things in history have happened when people stop thinking for themselves, especially when they allow themselves to be influenced by negative people. That’s what gives rise to dictators. Avoid that at all costs. Stop it first on a personal level, and you will have contributed to world sanity as well as your own. (Donald Trump)

Though I'm not addressing world sanity, I do think that the most important part of that quote is the importance of thinking for ourselves. If our "experts" aren't doing the job we pay them to do, it might be time to ask ourselves if they really know what they're doing and if they really know more than we do.

Don't be buffaloed by experts and elites. Elites can become so inbred that they produce haemophiliacs who bleed to death as soon as they are nicked by the real world. (Colin Powell)

Experts often possess more data than judgment. (Colin Powell)

If you disagree with AAHomecare's intentions, and are not willing to accept an adjusted competitive bidding program, now is the time for you to make it clear to CMS and to legislators that AAHomecare does not represent and does not speak for you.

The sad truth here is that it's extremely unlikely that round one can be stopped. That's another battle lost. But the war isn't over. It's time to regroup and to come up with plans (viable plans!) that don't include giving up the fight. Somewhere out there is someone who can step up and lead (not you, Rob Brant).

The vision must be followed by the venture. It is not enough to stare up the steps - we must step up the stairs. (Vance Havner)

Don't follow a bad plan blindly. Make sure you're being served.

Strategic Thinking

Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat. (Sun Tzu)

The Agony of Defeat
DME has had, in the battle against competitive bidding, several tactics, but no real strategy. Strategy requires a game plan with a cohesive team, and DME lacks a cohesive team.

I've heard over and over again that the national organizations talk to each other and "strategize" together, but I'm guessing that there's some selective hearing going on, considering how often they all contradict each other.

I've heard some rumblings, straight out of Medtrade, that make me pause. I'm pretty sure that some of these things aren't supposed to be common knowledge yet, but gentlemen (I use that term loosely in this case), if you don't want something known, don't discuss it on the show floor (I'm talking to you, Rob Brant).

I got an angry mail from one of my faithful readers telling me that AAHomecare has a new "strategy." The association is going to push for another delay so competitive bidding can be "fixed."

My source overheard Brant discussing this with another, unidentified person who appeared to be dissatisfied with this new delay tactic.

However beautiful the strategy, you should occasionally look at the results. (Winston Churchill)

The industry has already squandered a two-year delay during which nothing of any real value was accomplished. I guess the obvious questions are these: Will the industry ever think the competitive bidding process is right, and will the industry be reconciled to competitive bidding once it's fixed (again)?

What rocket scientist came up with this stupid idea?

I can hear the justifications now: If the industry can get a delay (another delay), that will give more time to repeal competitive bidding while CMS is forced to "fix" the process (again).

Did that "strategy" work during the last two years? No. So how are the "leaders" going to make that work for the industry now?

You have to be fast on your feet and adaptive or else a strategy is useless. (Charles de Gaulle)

The ability to adapt and maneuver quickly is crucial. As I've said again and again, the "leaders" in the industry embody the definition of insanity: doing the same things over and over again and expecting different results.

The delay tactic is doing the same thing over again, but expecting (or touting their delusional belief that they'll be able to achieve) different results.

A leader needs enough understanding to fashion an intelligent strategy. (John Kotter)

Is this the best that the national organizations can come up with?

I'm pluralizing organization because I'm assuming that, because they say they all "strategize" together, that they're in agreement on this redundant (and wasteful) tactic. If any of them wants to disown this plan, they can feel free to let me know and I'll be sure to pass it on here.

Tactics mean doing what you can with what you have. (Saul Alinsky)

The problem with doing what you can with what you have is that the DME industry doesn't really have anything. If it did, would it be where it is?

Think I'm wrong?

We all knew competitive bidding was coming when CMS did those two demonstrations; it was only a matter of time. MMA 2003 wasn't exactly a surprise, and though some people in the industry lobbied hard against it (except the Rob Brants of this world), deflection wasn't possible.

From the passage of MMA 2003 through the original round one of competitive bidding (enter Brant and his ilk after he/they didn't get contracts), five years of lobbying and trying to "educate" legislators did no real good. Yes, there were a couple of bills introduced. But what good did they do? None.

Just as H.R. 3790 will go the same way as other bills (which means it's a goner), the only thing the industry managed to do was get a delay, attached to the doc fix, that would "fix" what was (allegedly) wrong with the bidding process. In the meantime, the industry would use that time to get competitive bidding repealed.

Sound familiar?

Here's the irony, readers: Everyone in the original round one would have been better off financially if the delay to "fix" it hadn't been done. Reimbursements on the items were higher then than now; the delay actually hurt the people in the first MSAs far more than it helped.

Don't believe me? Check the reimbursements, then and now, for yourself.

So if you're in a round-one area and have "won" contracts, be sure to thank AAHomecare, the yahoos at AMEPA, and anyone else who participated in thinking up that delay tactic that ended up harming your bottom line.

Does this industry really need that kind of help? No. I shouldn't have to point that out to you, but sometimes it's hard to see the forest for the trees, isn't it?

People make bad decisions when they're in panic mode. The delay tactic was a bad decision. I'm sure it sounded good at the time to people in the original round one who didn't get contracts, but it would appear that no one was looking down the road.

Leadership has been defined as the ability to hide your panic from others. (Anonymous)

If you're going to panic, panic constructively. (Anonymous)

When the industry panicked, it didn't do so constructively, and the proof is in the results we have two years after the delay.

Degrees of Defeat
Different people will look at the situation in different ways. I see defeat, because the DME industry basically has no other cards to play. It has never gained the foothold it's so desperately needed in D.C., despite the money thrown at lobbyists and (ineffective) national organizations.

If you can accept losing, you can't win. (Vince Lombardi)

And if you don't have a solid strategy supported by logical and effective tactics, you can't win. You can quote me on that.

Victory has a thousand fathers, but defeat is an orphan. (John F. Kennedy)

Not this time, John. The fathers of the defeat that this industry has experienced are readily identifiable. Because you can't expect to experience victory if you have a flawed plan and no tools.

I really thought we'd win that. (Adolph Hitler)

I'm not going to bother with all those quotes that talk about defeat building character, or defeat being stimulating, or defeat being temporary, because I think they're all crap. Defeat isn't inspiring. Defeat hurts, especially when there's so much at stake. Defeat isn't opportunity. For most people, defeat is the end of the road.

Be careful that victories do not carry the seed of future defeats. (Ralph W. Sockman)

I think Ralph is talking about the delay of the original round one.

Does the industry need to continue to fight? Of course it does. But are the right people giving you the right tactics? What are the results showing you?

There are no bad regiments, there are only bad officers. (Field Marshall Lord Slim)

If you stand up and be counted, from time to time you may get yourself knocked down. But remember this: A man flattened by an opponent can get up again. A man flattened by conformity stays down for good. (Thomas J. Watson, Jr.)

The significant problems we face cannot be solved at the same level of thinking we were at when we created them. (Albert Einstein)

The way forward may not be clear right now, but the thing the DME industry must discard is what's already been done and not worked. You can quote me on that, too.

The Show Must Go On

This week is the Medtrade show in Atlanta. And I'm not there.

The only consolation I can find in your immediate presence is your ultimate absence. (Shelagh Delaney)

I used to go to Medtrade. At first I would attend some of the educational sessions, walk the floor, see and be seen, and go to the parties. As the years passed, I'd walk the floor, see and be seen, and go to the parties. The last time I went to Medtrade I walked the floor not caring if I was seen or who I saw, and then go to the parties.

And though I could write off the trip as a business expense, I decide that it was a costly investment to make considering the lack of return.

My own fault? To a degree, yes. I suppose that a show like Medtrade is what you make of it. But Medtrade got smaller and smaller, and the content of some of the education sessions got less relevant and less timely.

Part of the reason for the "slip" in content quality is, I think, technology. State and regional associations used to have to fax information to members, and because sending faxes involved long-distance phone charges, information sent out to members was somewhat measured.

Along came E-mail, and associations got more technologically savvy, which resulted in information being sent to members more frequently, in more detail, and at very little cost.

It's also far less expensive for me to attend my association's events than it is to attend a show like Medtrade. My association offers me excellent speakers, relevant topics, and timely information at a good price.

Why pay more?

Medtrade is a great place for DME providers to look at and compare products, and they might get some bargains from vendors along the way.

Man is an animal that makes bargains: no other animal does this - no dog exchanges bones with another. (Adam Smith)

Even the trade show portion of Medtrade was rapidly shrinking during the many years that I attended. Fewer and fewer vendors were willing (or able) to spend the money on exhibiting at the show; there was little or no return on the investment. And that I can well understand.

More and more DMEs are needing to find less expensive equipment, especially those in the first round of competitive bidding.

There are very honest people who do not think that they have had a bargain unless they have cheated a merchant. (Anatole France)

At the bid reimbursement rates, the manufacturers and distributors are probably going to end up feeling like they've been cheated if they have to cut their rates to move their equipment. The thing is that there are costs associated with manufacturing and distributing, and a company is in business to make money, not give their merchandise away.

But providers are also in business to make money, and with reimbursements slashed, they can't afford what they were once able to buy. It's a real conundrum.

To Go or Not To Go?
I did consider going this year. I'd been told that at last year's show, and at Medtrade Spring, the state associations were finally given space at the event (free of charge!), and this is a good thing. Most of the state or regional associations (with a few sadly obvious exceptions) are the workhorses of the industry, and they deserve the recognition and the break.

I'm a bit puzzled, though, about why some of the associations attend the Medtrades that they do. I'll explain:

NCAMES and VADMEC were at Medtrade Spring this year; they're also at the Atlanta show now. I can understand being in Atlanta, but I'm mystified about those two east-coast organizations being at the Vegas show.

Medtrade Spring is a smaller event, and I can't imagine that the NCAMES and VADMEC members (and potential members) go to Vegas in droves. Unless east-coast associations (we'll throw NEMED and FAMES into the mix too) are signing up bunches of members in Vegas, I don't understand why they're paying money to be there.

I know people who attended Medtrade Spring this year, and I know that FAMES was very loosely represented there (and by loosely I mean an unmanned table in the association area; tossing some literature on the table and being gone 90% of the time isn't exactly representing the organization or being available to existing and potential members). Funny thing is that FAMES has no table in the association area of the Atlanta show. It seems to me that the Atlanta Medtrade is far more relevant to that organization than the Vegas event could ever be.

MAMES, MESA, and other associations central in the country attending both makes more sense, though I suspect that there are greater gains for those organizations in Atlanta than in Vegas.

As for CAMPS, I'm just not sure how profitable it is for a California association to be at an Atlanta show, but they're there.

And where is OAMES?

The thing that I can say, even if I don't understand why some of them go where they go, is that the representatives of NCAMES and VADMEC (Beth Bowen), NEMED (Karyn Estrella), MAMES (Rose Schafhauser), and MESA (Elizabeth Moran) actively connect with their members.

And maybe that's the point of them attending both Medtrade events. I'm looking at it from a financial perspective.

I don't think going to the events is about ego, because none of the Executive Directors, with the exception of one, highlights himself or herself on their respective web sites or in other promotional literature that I've ever seen (the exception being FAMES where, if you click on "about us" you get a personal bio, complete with mention of that E.D.'s consulting firm, but no information about FAMES, which is what I'd expect and hope to find; even AMEPA, FAHCS and TAHCS don't do that).

Okay, the PAMS site has a blurb about John Shirvinsky, but as side-bar, not as the the sum and total. That's appropriate, and the blurb is very well done.

Don't get excited, AMEPA, FAHCS and TAHCS. I haven't changed my opinion of you, and I'm not softening up. I'd expect class-less, personal self-promotion from your bunch; I'm merely disappointed to see something like that from an organization that should know better.

Anyhow, back to the point: It's not about them, the individuals; it's about them as representatives of and advocates for their members. That's my guess. Maybe they see their participation in both Medtrades as a worthwhile investment from an interaction point of view.

But I'm a dollars-and-cents person, and if I'm going to spend my time and money on an industry event, I'm going to invest in my state (or regional) association's production. They need the money and I'm going to see more of a return both in the long and short runs. Am I telling you, dear reader, to not attend Medtrade? No. It's up to you to determine how your own interests are best served, and if the Medtrades work for you, then that's where you should go.

Just don't forget how hard your associations work (most of them, anyhow); please support them.

Speaking of Shows ...
Are you paying attention to what's going on in D.C. after elections? So far we still have the same squabbling and the same power-plays; I don't think legislators got the message sent to them by the angry electorate.

Are you surprised by that? I'm not.

For those of you who live in districts sending new faces to Washington, make plans to open dialogues and get to know them and their staffs. Tell them about what you do and how it benefits the beneficiary community. Don't wait to begin your efforts; do it now. Get the jump on CMS by educating them; start a proactive and productive conversation instead of the rushed, angry, and reactive relationships the DME community is typically forced to have.

Arm them at the beginning with your side of the story. It may help down the road when the industry needs it.

Dropping the Pilot

I've run across several articles and blogs that discuss the possibility of Texas withdrawing their Medicaid program.

Sixty percent of Texas Medicaid is funded by federal funds. Even with the funding the program receives from the federal government, the Texas Medicaid program is a huge expense for the state.

I suppose this is true for most states.

Medicaid programs do good things for people in dire need. There are well over three million children enrolled in the Texas Medicaid program, as well as adults with disabilities and what one blog referred to as "impoverished" Texans.

The Helpless
I'm sympathetic toward very ill children who need care that their families simply can't afford. I can't imagine being in that position (as either parent or ill child), but it's good that a program is available that will help fund the care of a child in need. I don't begrudge them assistance.

It is hardly possible to build anything if frustration, bitterness and a mood of helplessness prevail. (Lech Walesa)

The Hopeless
There are also adults with disabilities who cannot work, and so need assistance with medical issues. Are there some with legitimate, debilitating illnesses that make these unfortunates seek assistance from state programs? Without a doubt.

But then there are those who are perfectly capable of some form of work, and some form of productive activity, but who play the "illness card" that enables them to receive benefits -- both medical and income -- for little or no effort. It's their "disabilities," you see.

I personally have known several people who fall into that category. I don't know them for long, because I resent parasites.

Sure I am a freeloader but my morals permit that. (Anonymous)

From Each According to His Ability ...
To each according to his need. This is an appalling philosophy. I remember talking to someone several years ago who was adamant that the legend of Robin Hood was one of the worst and most irresponsible crimes perpetrated by humanity on humanity.

She maintained that it was an abomination to encourage the mindset that taking from the productive "rich" to give to the undeserving (and useless) poor was moral and right. She wasn't wealthy; she worked for a living, and wasn't looking for or expecting hand-outs. But she did resent that some of the taxes she paid went toward the upkeep of society parasites.

Yes, she was one of those who adamantly supported welfare turning into workfare, and drastically limiting the free ride too many get.

I was, at the time, surprised; I thought, at the time, that she was being a bit cold. But as the years have passed, more and more people are getting an entitlement mentality, and I now see what she was saying. I also find that I agree.

The welfare of each is bound up in the welfare of all. (Helen Keller)

Why does society today perpetuate the myth that we are all our brothers' keepers? Why are those who work obligated to fund the lives of those who don't? I don't mind that some of the taxes I pay help those who are in legitimate need, but just because someone is "impoverished," doesn't mean they should be entitled to a free ride at my expense.

There are millions and millions who work, contributing to society and taxes, and they don't have health insurance because they can't afford it. Do they get state benefits? No. They don't qualify because they're too wealthy.

Huh?

Let me get this straight: The productive members of society can't benefit from what they pay in by getting assistance from the state? How is that right?

Aliens Among Us
One blog had a comment from someone who said that it's okay for Texas to drop Medicaid because of all the illegals in it.

Illegal is anything that is against the law including drug trafficking, smuggling, terrorism or crossing the border into a country. Undocumented is anything that can no longer be verified including unemployed American workers who no longer qualify for unemployment benefits and are no longer counted in statistics. What a sorry nation we are becoming when we allow corporate political correctness to pervade our daily speech. Illegal means illegal. (Peter Romanenko)

I'm a curious person, so I checked to see if Texas Medicaid has any citizenship requirements, and it does. There is, however, an exception. A pregnant illegal can get medical coverage through the Medicaid program. So Texas citizens are footing the bill for illegals to have children in the state.

Illegal means illegal. Pregnant illegals need to be sent back to their home countries, not permitted to leech from a system into which they do not and are not likely to ever pay.

True charity is the desire to be useful to others without thought of recompense. (Emanuel Swedenborg)

I'm not opposed to being charitable. But what I am opposed to is having my pocket picked by lazy, useless people.

Charity is injurious unless it helps the recipient to become independent of it. (John D. Rockefeller)

Exactly, John. The government "support" programs today don't encourage the recipients to become independent of them; they only encourage the vast majority participating to work the system as long as they can.

Capital punishment is as fundamentally wrong as a cure for crime as charity is wrong as a cure for poverty. (Henry Ford)

I disagree with Henry Ford on his capital punishment stance, but agree absolutely that charity is wrong as a cure for poverty. The more people get for free, the more they want (and the more they think they're entitled to have). Welfare, disability compensation, and Medicaid are charity.

Government Wants Poor People to Die
That's a ridiculous statement, but bleeding-heart liberals say things like that when entitlement programs are threatened.

I've often wondered how much of their own time and money liberals donate to their causes; it's more advantageous for their purposes to have the tax-payers fund their generosity. In their minds, society owes the poor (and the lazy), and society should give 'til it hurts.

Ladies and gentlemen of the liberal persuasion, I have news for you: It hurts. In fact, it's been hurting for quite a while now. And I, for one, have had enough of throwing money at people who make no effort to help themselves.

Tightening Up In Texas
The Texas legislators who want to bid farewell to the Medicaid program know that they'll have to find an alternative that will continue to address the needs of the truly needy.

Texas won't be dropping the pilot by dropping out of Medicaid, if that's what they end up doing. What Texas would accomplish is escaping the too-broad and too-expensive federal guidelines and requirements of a program that's too easy to milk.

In participating in the Medicaid program, and receiving federal funds for that program, Texas is obligated to play by federal rules, which are so loose that the state pays out more than it should. Texas has to offer Medicaid entitlement programs (and dollars) to individuals they might, if they had the power, (correctly) reject.

My main concern is what such a move would do to the DME industry. And this is something that suppliers in Texas need to think about as they keep an eye on the future of Texas Medicaid.

The Winner Is: No one!

Always mystify, mislead and surprise the enemy if possible. (Thomas J. Jackson)

That quote seems to be the philosophy of CMS. DME is the enemy, and the agency seems to take great delight in mystifying, misleading, and surprising the industry.

Eighty percent of all surprises are unpleasant. This includes bills, estimates, unkept promises, firings, birthday parties, and pregnancies. (William Marstellar)

I'm going to add legislation and anything CMS does to the unpleasant surprises that appear in the quote above. The agency has a gift for springing news on the industry very late in the day. Because they do that so often, I think it's safe to say that even the village idiot knows that they do it on purpose.

Americans of all ages deserve quality end-of-life medical care. (Bill Nelson)

Nice one, Mr. Nelson, but who defines quality?

In politics people give you what they think you deserve and deny you what they think you want. (C. Northcote Parkinson)

This explains healthcare reform and CMS's approach to the DME industry.

So we know now who the bid winners are for the re-do of round-one. Is anyone surprised by the results? I'm not. I expected to see many of the company names that appear on the lists.

Oh, I raised my eyebrows when I saw that Rob Brant's company and Barry Johnson's company got contracts; so much for principles, huh? I suppose it's all well and good to be philosophically opposed to competitive bidding, but it's okay to embrace and participate in the process because one has to to feed one's family (or something along those lines).

It may be that because they're so publicly "passionate" about their anti-competitive bidding stance, I naturally assumed that they'd not want to participate in a program that would destroy the businesses of so many of their friends and supporters (well, okay, the few that they actually have; it's not like I'm talking about a crowd here).

It's easy to be against something when you're shut out; Rob Brant's company failed to get a contract in the original round one, and so he suddenly (and very belatedly) became an ardent industry activist.

There's nothing like being left out in the cold to get you moving, right? I'll be interested to see what happens going forward. Wont you, dear reader?

We must not tolerate oppressive government or industrial oligarchy in the form of monopolies and cartels. (Henry A. Wallace)

I suppose the argument could be made that, because there are many "winners" in the round-one MSAs, the government hasn't created monopolies. The companies that got contracts will still have to compete with each other for new referrals and for beneficiaries.

America is at that awkward stage; it's too late to work within the system, but too early to shoot the bastards. (Claire Wolfe)

Even though there will have to be competition among those left standing, the sad truth is that too many of those who didn't "win" contracts are going to suffer. And there's no solution in sight; 3790 is dying a quiet death, there's still no one willing to introduce a companion bill in the Senate, and by the time the industry rallies again, competitive bidding will have been implemented and Congress will adopt a wait-and-see attitude.

And some of the current crop of "winners" won't make it either. The reimbursements are so low that some companies won't be able to manage. Which means the provider gene pool will shrink even more.

What's the answer? There isn't one, at the moment. But while all this is going on, the industry needs to take note of and document every single failure of the competitive bidding program to use as ammunition against CMS and to use as justification (and inspiration) to make legislators do something about the bid.

I know I'll be keeping an eye on things, but that can't come as any real surprise, right?

And just when you thought you were the coolest person in the room, I walked in. (Unknown)