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.