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)