Delusions of grandeur make me feel a lot better about myself. (Lily Tomlin)
Leadership is a tricky thing. There are those who are natural leaders, those who are competent-if-uninspiring leaders, and then those who shouldn't be allowed out without keepers.
One of the wisest things a person can know about himself is what his limitations are. A lack of self-knowledge is a dangerous thing; this and an overinflated view of one's own importance can lead to delusions of adequacy (never mind grandeur for the moment).
The last couple of days have been very busy for me. I've been the recipient of a flurry of mails packed with information. Some of it I can verify (quite a bit of it, actually), and some of it I have to take on faith. What I do know is that the people who send information to me want it out there and are unable, for whatever reasons, to do it themselves. And so they send it to me.
And I give it to you.
I have no delusions of grandeur. I know my limitations. I don't presume to speak on behalf of anyone. I gather information, sort through it, form opinions, and blog. I leave it to my readers to decide if they agree with me; I leave it to my readers to decide if they're going to act on what I have to say. What I don't do (and won't do) is delude myself into thinking that I represent or speak for anyone else.
spokesman [ˈspəʊksmən], spokesperson [ˈspəʊksˌpɜːsən] feminine, spokeswoman [ˈspəʊksˌwʊmən]
n pl -men, -persons, -people, -women
a person authorized to speak on behalf of another person, group of people, or organization
The most important word in that definition is "authorized." Taken in context, it means "approved." So a spokesman is an individual who is approved to speak on behalf of another person, group of people, or organization.
One of the mails I received is a copy of an email alleged to have been written by Rob Brant. In it he states that "the round one suppliers would like a 6 month delay based on the following problems." I'll get to those specific problems in a moment; I'm going to discuss the obvious first.
I don't know how many of my readers are in a round-one bid area, but how many of you told Brant that you would like a six-month delay? And how many of you authorized Brant to be your spokesman?
I concede that Brant is a spokesman for AMEPA; it's his club, after all. AMEPA is a for-profit corporation, formed on March 28, 2008, and based in Miami (at the very same address as Brant's DME, City Medical Services). The first "benefit" of membership (read: giving AMEPA "dues" money), as stated on the AMEPA site, is "The Membership Fees support our national efforts for an adequate resolution of the DMEPOS Competitive Bidding Program."
At one time Brant's stated goal was to get rid of competitive bidding entirely. At the time he formed AMEPA, Brant said that he did so because no one was really doing enough to get rid of the program. More than two years later, AMEPA hasn't done enough either. In fact, Brant seems more interested in being a board member of AAHomecare than in his own organization. Why AAHomecare would embrace Brant is a mystery to me, though I've heard rumors that they did so to "control" him.
How's that going for you, AAHomecare?
So what, exactly, is an "adequate resolution" of the program? A six-month delay? To what end? Below are the contents of the Brant email with my comments in italics.
The Mail
Here is the argument to the Obama administration, or Congress to delay Round One from beginning on January 1, 2011. The Round One suppliers would like a 6 month delay based on the following problems:
I've had comments from round-one suppliers who don't want a six-month delay, which contradicts Brant's claims that they want one.
1) CMS delayed the release of the bid winners by 2 months. The names were supposed to be released in September and they were finally released in November, intentionally after the General Election, when it was too late for Congress to act.
There was indeed a delay in releasing the names of the winners, but it's quite a stretch to attribute that delay as being one engineered to be too late for Congress to act. Congress has had two years in which to "act." Would announcing the contract winners prior to elections have mattered? Would that have prompted Congress to take action? Would it have inspired a Senator to introduce a companion bill for H.R. 3790? No. And here's the thing: the elections are over, but the same people are still in Congress, until January, and could still act.
2) CMS sent information promoting the program to beneficiaries, but did not send a list of bid winners to beneficiaries. Beneficiaries, physicians, case managers, and hospital discharge planners have been directed to find providers thru the medicare.gov website which is confusing and misleading. Many beneficiaries, in need of Home Medical Equipment do not have access to the internet and neither do their part-time caregivers.
There are many beneficiaries who are quite internet savvy. Those who are not can call 1-800-MEDICARE to find out which suppliers are Medicare contract suppliers as an alternative to going online. This alternative is also in CMS literature sent to beneficiaries. Telling a half-truth erodes credibility. Is this the best Brant can offer?
3) 258 legislators understood that this program is not really Competitive Bidding because it is a bid without any financial accountability. Additionally no real bidding program would allow out of area, inexperienced, and financially bankrupt companies to win bids and set prices, only to walk away from the program or sell their companies/bid contracts.
258 legislators might have agreed to support H.R. 3790, but without Senate support, the House support is, in a word, worthless. As for what a "real" bidding program would or would not allow, how is Brant qualified to make such a statement?
4) Due to CMS’ political maneuvering, the industry did not have the opportunity to raise arguments of 166 top auction experts/Economists and the problems of out of area, inexperienced and financially bankrupt and insolvent bid winners to the 111th Congress. The results will be a lack of compliance by patients, more work for case managers, longer hospital stays, more bankruptcies, more unemployment and loss of local access to beneficiaries.
The industry has had more than two years to point out the flaws of the program. The economists/experts released their collective opinion in September. Is Brant saying that between then and now the industry didn't have time to tell legislators about it? What does Brant want to do, retool the bid so that it actually succeeds? That's a great idea. Let's have some experts tell them how to do the bid right so that it actually works.
We need it to fail.
5) At this point we would not ask to delay Round 2. We could Delay Round 1 without delaying the January 2013 start and the bulk of Medicare’s proposed savings of Round 2. Besides, Medicare claims that the program is perfect “as is” and they do not anticipate any changes to Round 2. Just because Round 1 is delayed 6 months, does not mean that Round 2 should be delayed at all.
No delay to round two? Why not? Is it because Brant doesn't own a DME in a round-two area? What kind of logic is being used here? This begs for explanation, and those who are facing round two should be up in arms over this.
Even using the most exaggerated savings (created by out of area, inexperienced and financially bankrupt and insolvent bid winners), the CBO claims the DMEPOS Bidding Program will save $20 Billion over 10 years. The bulk of that savings will come from 91 MSA’s in Round 2, including the largest areas: New York City, Los Angeles, Chicago, Philadelphia, Atlanta, etc.
The savings were based on projected reimbursement savings, not by the bid winners.
Using basic math (which I am sure does not apply here) $20 billion over 10 years = $2 billion per year.
No, really? Did you figure that out with or without a calculator?
The 9 Round One MSA’s roughly consists of 9% of the proposed savings. Nine percent of $2 billion = $180 million.
Half a year of that proposed savings = $90 million. I do not remember if the CBO calculated an additional compounded savings, three years after the Round One and Round Two are rebid. If that is the case, the savings for 6 months would likely be much less than $90 million.
If you base your premise on something you believe to be flawed, then your premise is flawed.
If the industry had time, an argument could be made that $90 million is not a large sum of money to delay a program which will certainly cause so many problems. However with only a few weeks left, a change in Congress, and the House and Senate leaders general feeling about our industry, we will likely have to offer a budget neutral proposal to delay the program. Below are a few option ideas.
How much more time do you need? Many years have passed since the industry started arguing against competitive bidding. What do you honestly think can be accomplished in a six-month delay?
OPTION 1:
An offset by taking future CPI-U cuts nationwide, that we will never see anyway, and that the industry will not really feel?
The industry feels every single cut.
OPTION 2:
Perhaps a nationwide cut of 0.5% or 1% to delay the program 6 months
It's extremely dangerous to imply that the industry can swallow more reimbursement cuts. And who authorized Brant to make that kind of an offer?
OPTION 3:
Perhaps an immediate cut to the Round One MSA’s of 2.5% in addition to a national cut of 0.5%. This solution may have a better appeal to the national community of HME providers. Although the additional cut to Round One would likely be more symbolic, than a necessary pay-for mechanism.
So Brant wants round-two DMEs to help pay for a delay from which they won't benefit? "Just because Round 1 is delayed 6 months, does not mean that Round 2 should be delayed at all." Yet Brant wants them to foot the bill? I can't imagine how the "national community of HME providers" would support that, and they shouldn't.
OPTION 4:
A combination of OPTION 1, OPTION 2, or OPTION 3
OPTION 5: NONE OF THE ABOVE!
My source told me that a supplier commented thus: Brandt (sic) is trying to protect individual suppliers (i.e., himself) rather than looking at the big picture. If the email and the plan therein does, in fact, belong to Brant, I will say that I think that his company's preservation is a motivating factor in his approach (though let's not forget that he's got a bid contract in his pocket, and so has a better chance at survival than most). Is it the only motivating factor? I don't think so. I think that Brant is having delusions of adequacy, and that somewhere along the way he started believing his own press (generated by shameless self-promotion, not based on actual accomplishment). I've stung him on several occasions for being very late to the fight-competitive-bidding party, and rightly so.
A better-late-than-never mindset may be applicable to parties, but it's not applicable to something this important.
If Brant is driving AAHomecare's activity and strategy these days, each and every one of you needs to think long and hard about whether or not you authorize them separately or them collectively to be your spokesman. You have to decide whether or not you agree with the message they're sending and the deals they're attempting to make. Everything they say and do has the potential to have a profound effect on you and your business.
You have the right to decide who speaks for you, and you have the right to have input on the message your spokesperson sends. In the end, the person who represents you works for you, and your interests must be served.
You also have the right to make it clear who does not speak for you. If an organization approaches government agencies and legislators with a plan you don't support, tell the government agencies and legislators that you disagree.
Silence implies consent.
You have other options out there. AAHomecare isn't the only game in town. I haven't seen much out of VGM on the six-month delay plan, so I can't tell you whether they support it or not. Another option for providers is NAIMES. If you're looking for an organization to get behind, ask them what their positions are. Ask them what their plans are.
Competitive bidding needs to fail, not be delayed while it's improved. If that means that round one must go forward as is, that also means that failure is more imminent. Am I comfortable with sacrificing some people in the round-one areas? No. But I'm far less comfortable asking for a delay to help CMS make improvements to a program that will ensure its success.
The truth is that failure will save the industry.
Collective Effort Minus One
Coming together is a beginning. Keeping together is progress. Working together is success. (Henry Ford)
There's a site out there that almost all industry organizations are urging round-one providers to use to report bidding-related problems:
www.competitivebiddingconcerns.com
There is a notable exception, however, and that is AAHomecare.
Show me an elitist, and I'll show you a loser. (Tom Clancy)
AAHomecare is using its own site to gather information on bidding-related problems. There is a time and place for establishing an independent identity, but it isn't now and it isn't there.
He who stands aloof runs the risk of believing himself better than others and misusing his critique of society as an ideology for his private interest. (Theodor Adorno)
Most providers, if they're going to report problems, aren't going to do the same reporting in two different places. It's time for AAHomecare to learn to play well with others and pool all knowledge in one convenient place.
The foolish and the dead alone never change their opinions. (James Russell Lowell)
Now is not the time for a stiff-necked, aloof stance. AAHomecare can only improve its declining position by openly cooperating with others; it needs to really listen to the industry, regroup, and come up with a plan that people will want to get behind.
An association with no members isn't an association for very long.
To most of us the future seems unsure. But then it always has been; and we who have seen great changes must have great hopes. (John Masefield)
I think if everyone can get behind the failure of round one, the industry will win in the end. But we have to support failure together.
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