Partnerships, Professionals, and Parasites

Partnerships
One of my readers forwarded an announcement to me about NAIMES and Brightree forming a "strategic alliance" (whatever that is) that will "help providers stay informed about industry legislation and help promote advocacy efforts to better the DME community."

The announcement goes on to say: "Under the partnership, Brightree and NAIMES will work together to develop a series of informational programs to help Brightree’s customer base stay informed about various topics, such as competitive bidding, that have a significant impact on the industry."

I'm all for offering new services to customers, but if these "informational programs" have fees associated with them, and if these "informational programs" are offered to providers who aren't clients of Brightree, then I see the potential for conflict.

The state and regional associations already offer informational programs to help all DMEs stay informed about various topics that have a significant impact on the industry. They work hard to do that. I see partnerships like the Brightree/NAIMES one as potentially undermining the associations and draining off resources that these organizations need. Brightree and NAIMES should be working together to encourage Brightree's customers to join the state and regional associations. Investing in them (most of them) is investing in the industry.

I've complained before about businesses and "service organizations" offering their "informational programs" to all who are willing to pay. Even if the Brightree program is free to its customers, the fact is that the advocacy efforts of the state and regional organizations cost money, and implementing programs that compete with them (directly or indirectly) is, in my mind, a bad move.

There are some associations that don't offer seminars, or some that produce events that don't quite meet the needs (or expectations) of providers in the area. Content and quality are components that are crucial to education, and if an association is offering what I consider to be "crap" events (teleconferences on rah-rah sales come to mind), I'm not going to attend (not even if stuff like that is free to members).

I'm probably not going to be a member, either, if this is all an organization has to offer.

A good association keeps its members informed. Most do that. They wade through the masses of information they get from multiple sources, sort the needed info from the useless, and send the good nuggets to members.

A good association offers seminars (live, web, and tele) that inform, educate, and are useful to the attendees. I'm not against sales seminars, mind you, but I don't want or need them on a steady basis. Are sales important? Yes. I need a good sales person (or people) to court referral sources. But do I need (or want) sales-related content every month? No.

What I want -- what I need -- is an organization that tells me what's going on with Medicare and what's going on in my state. I need an association that tells me when it's time to be legislatively active (and what to say while I'm being legislatively active). I need an organization that can answer my questions and help me when I need it (or point me in the direction of a person who can help me if my association can't). I need an association that's going to produce events that I can attend for timely information, instruction, and the opportunity talk face-to-face with my peers.

I want a lot, it seems. But many of the state and regional associations that serve the DME industry do all that and more, even though they're under-funded, under-staffed, and under-appreciated.

In most cases, I'm going to trust that the professional running the association I belong to knows what he or she is doing, and is qualified to select good speakers to talk about topics that will have an impact on my business.

I had one person tell me that he didn't belong to the industry association serving his area. He wasn't a non-member because he couldn't afford it, and he didn't choose to not join because the association wasn't a good one. He didn't join because he benefited from the organization's activities without having to pay. They were doing what they were doing without his money anyhow, right? Why pay for what you're going to get free?

My response was to point out that the associations could do more if they had more support (more members means more dues revenue, which means more money to fund efforts). Associations make up for absent dues revenue by producing educational events. Associations support the industry as a whole, not just their clients, and they need "strategic alliances."

I don't often frown at NAIMES, but in this particular case, I must. Though it's nice that Brightree is working on informational programs for its client base, NAIMES would do well to assist the state and regional associations as strongly and as publicly; no one does industry advocacy better or more diligently than they do (in exchange for very little praise and even less recognition).

Professionals vs. Parasites
There are a few cases where industry associations are not run by professionals. Though these few might fancy themselves as qualified to run an industry association because they used to be in the industry or served on the association's board, the fact is that those individuals are rarely successful, which in turn has a negative impact on the organization itself.

Worse yet are associations run by "consultants."

Consultants are people who borrow your watch and tell you what time it is, and then walk off with the watch. (Robert Townsend)

Some consultants are like the bottom half of a double boiler: They get all heated up but don't know what's cooking. (Anonymous)

A consultant is someone who saves his client almost enough to pay his fee. (Anonymous)

Before any consultants reading my blog go postal on me, let me state for the record that there are some good consultants out there. The good ones come in and accomplish what they said they would (which sometimes means that the good consultant must have super-human powers because we can make some big messes of our businesses).

I was at an event and overheard someone grousing about his association and the person running it. He needed some help with a specific issue, and had turned to his association for similar help in the past, so he went to them again. The problem was, he said, that the association was now run by someone else, who seemed more interested in getting him to pay consulting fees than offering him the help he'd always had from his association in the past.

An association should not be a tool used to get clients for the consultant running it; that's parasitical.

If I need a consultant, I'll hire one after careful research of qualifications and experience. But if I'm a member of an association, I've paid for member services, and I'm going to look to the organization for a certain amount of assistance when I need it. Maybe the answer in the scenario I overheard is for the organization to spell out exactly what services a member is entitled to expect, which would avoid misunderstanding.

Or maybe the answer is to have professional staff, which will head off perceived conflicts of interest.

I'm a firm believer in supporting useful associations. I support them by paying dues and by attending the educational sessions they offer because in doing so I contribute to their survival, which in turn helps my business. The relationship between small business and the association to which that small business belongs is symbiotic.

There are several industry conferences coming up in the next few months. Take a look at what your state or regional association is offering and attend, even if you're not a member. Those events offer a more intimate experience than, say, a Medtrade, and in most cases, the sessions presented are tailored to your environment.

We go forward into an uncertain future, but we don't have to go forward alone or uninformed. Form a partnership with your association today.

Blessed Blessed Silence

I love peace and quiet, and am never uncomfortable in silence, because I always appreciate it.

I've had a couple of readers ask me if I've noticed that TAHCS has gone silent, and I can honestly respond that no, I didn't notice. Sometimes the absence of something, no matter how annoying and dim-witted that something may be, doesn't register, no matter how welcome that absence is.

And the absence of the self-serving, pompous, sub-literate, and too-often-false babble that TAHCS inflicted on the DME world is a welcome one.

Silence is the best answer for and from the stupid. (Stating the Case Blogger)

TAHCS has always touted itself as being the "pro-active" association for DMEs in Texas. They threw the "United we stand" slogan around alot too.

I always thought that the most "pro-active" thing that TAHCS could do was to disappear.

Yes, I'm told that Barry Johnson got up and spoke at a couple of Texas Medicaid meetings (the ones about that state's incontinence bid), but did TAHCS submit any alternative proposals? Nope. I've seen the one that MESA submitted, and it's extremely good. If that bid goes forward in Texas, it won't be for lack of effort on MESA's part to stop it.

It should come as no surprise to anyone that TAHCS can't say the same about its "pro-active" efforts on behalf of Texas DME providers.

The TAHCS guys have exhibited no sense of discretion; that lack goes along well with their extremely economical use of truth, their apparent deficiency in knowledge of the English language, and their utter lack of professionalism (Barry Johnson and Dean Cheney showing up at some MESA events are some great examples of no professionalism).

TAHCS was like a half-assed firecracker. It just fizzled out real quick and made a loud noise. (An edited quote borrowed by the Stating the Case Blogger from Jersey Shore's "The Situation")

Signs point to TAHCS being no more, and that's a step in the right direction for the industry.

AMEPA, it's your turn.

DME Should Be Like Bowling

We the people, in order to form a more perfect UNION ... (Preamble to the United States Constitution)

I correspond with some of my readers on a regular basis; I talk with some more than others. In one recent exchange, I said that I had some radical thoughts on tactics for the industry, and the person with whom I was talking said this:

"I think the industry should go in another direction as well and I'd love to hear your radical thoughts. You never know, someone might listen and get other people to listen. The certain fact is that we're dead if something doesn't change and soon. AAHomecare does not have a clue what to do except [continue] to talk to bureaucrats."

Most people are conditioned to think of something radical as being a bad thing. So let's take a look at the word "radical."

rad·i·cal
adj \ˈra-di-kəl\

1: of, relating to, or proceeding from a root: as
a (1) : of or growing from the root of a plant (radical tubers) (2) : growing from the base of a stem, from a rootlike stem, or from a stem that does not rise above the ground (radical leaves)
b : of, relating to, or constituting a linguistic root
c : of or relating to a mathematical root
d : designed to remove the root of a disease or all diseased and potentially diseased tissue (radical surgery) (radical mastectomy)

2: of or relating to the origin : fundamental

3
a : very different from the usual or traditional : extreme
b : favoring extreme changes in existing views, habits, conditions, or institutions
c : associated with political views, practices, and policies of extreme change
d : advocating extreme measures to retain or restore a political state of affairs (the radical right)

4: slang : excellent, cool

I'm using "radical" as defined in 3a and 3b.

It is one of the characteristics of a free and democratic nation that it have free and independent labor unions. (Franklin D. Roosevelt)

I think that most people view being "radical" the same way they view people who are described as being "extremist." The two words are compatible, but the immediate tendency to put a negative spin on both words is not always correct. These days we're using the words "radical" and "extremist" most often in relation to terrorism and crime, and though the use of the words in that context is entirely appropriate, there are other ways in which to use them that aren't as negative.

Context is very important.

Our country was founded on radical and extremist thoughts, ideas, and actions. If not for a group of people who were willing to do what it takes to achieve an end, the United States of America wouldn't exist.

It's probable that, at the time of the American revolution, the English government thought of the rebels across the pond as radical and extremist. Did our founding fathers see themselves in that light? Probably not. Who's right, and who's wrong?

Both; it depends on what side of the fence you're sitting on. My point is that out of radicalism and extremism, positive things can come to be. Will everyone see the outcome as positive? Of course not. Viewpoint and context color the opinions of all sides.

Conflict is the gadfly of thought. It stirs us to observation and memory. It instigates to invention. It shocks us out of sheep-like passivity, and sets us at noting and contriving. (John Dewey)

There are many types of conflict. There is man versus man, man versus nature, man versus himself, and man versus society (just to name a few basic ones).

There's one type of conflict in which the DME industry has been embroiled for more than a decade, and that's man versus government. In my view, this particular conflict is a complex one, because I see it as a combination of man versus man, man versus himself, and man versus society.

It's frustrating when a conflict is largely one-sided. The industry speaks, protests, and lobbies, but gains no ground because it holds no cards.

Or so we've been led to believe.

True Lies
It's true that the industry holds no cards; it's a lie as well.

I know what you're thinking: Huh?

If the industry plays by the rules and employs the tactics it's adhered to for the last ten-plus years, then it's true that it holds no cards. This has been obvious for many years; the complete lack of progress bears this out.

To those who would argue that the industry has been successful in its fight because round one was delayed for two years, I say this: It's been implemented, and the threat of round two looms quite threateningly. The delay accomplished even lower reimbursements for those in the round-one CBAs, and this bodes very ill for those now facing round two. In short, the delay did more harm than good.

There are no failures - just experiences and your reactions to them. (Tom Krause)

With all due respect, Mr. Krause is basically full of **it. A Pollyanna perspective doesn't make a failure any less of a failure. If you set out to accomplish something and don't get it done, you've failed.

Remember the two benefits of failure. First, if you do fail, you learn what doesn't work; and second, the failure gives you the opportunity to try a new approach. (Roger Von Oech)

Any reasonable person would learn what doesn't work from failure, which would (should) lead to a new approach. It is unfortunate that this hasn't happened to the "leaders" of the DME industry. I've said over and over what the definition of insanity is and how industry leadership is the personification of that definition, so I'm not going to go into that in today's blog.

What I am going to discuss is a new approach.

Tick Tock
We're running out of time. Round two is supposed to start this year. Once that's implemented, I have a sick feeling that we're done for.

We didn't lose the game; we just ran out of time. (Vince Lombardi)

The Industry Strikes Back
The namby-pamby approach used for the last decade hasn't worked. AAHomecare is ineffective. My correspondent was right when he or she said that AAHomecare does not have a clue what to do except to continue to talk to bureaucrats who very clearly aren't listening.

Do not wait to strike till the iron is hot; but make it hot by striking. (William Butler Yeats)

During the original round one and the round-one re-bid, I heard many people saying that the best way to kill competitive bidding would be if no one in the CBAs submitted bids.

This would have been a good tactic, but of course it didn't happen. Some suppliers were motivated by greed (I'm talking to the idiots who submitted the low-ball bids with a winner-take-all mentality) or motivated by fear. It may be cliche, but fear is indeed a great motivator.

They say that absence makes the heart grow fonder. There are people I know I wouldn't miss if they suddenly disappeared, but in general terms, the saying is true.

There's another saying: You don't know what you've got until it's gone. Though this is usually used when discussing love and relationships, it's true in other areas too.

Sometimes in order to teach how important a thing is, a good strategy is to take that thing away. Deprivation is an excellent teaching tool. We use it with our children, don't we?

So what would happen if the DME industry went on strike?

We tell legislators and CMS how important we are. Maybe it's time to show them.

Yes, we feel a responsibility to and for our patients. Forgive me for being entirely pragmatic, but I feel compelled to point out that we didn't take the hippocratic oath. That so many of us are as ethical as we are speaks volumes about the integrity of the people in the industry.

But we are under-valued and under-appreciated. Our importance to care in the home and the money we save the Medicare program is ignored. This is why the years we've spent talking and pleading have fallen on deaf ears.

We protest, but then ultimately submit because our "leaders" have nothing to offer us (I'm talking to you, AAHomecare. I'd be talking to AMEPA and Rob Brant as well if they were of any real value and had any credibility, but they don't.). Industry "leaders" are afraid to employ stronger tactics because the industry might make legislators and agencies angry, but in pussy-footing around, we've only lost ground.

The end result is AAHomecare looking to modify competitive bidding along economists' lines so the program will actually work. If that doesn't shake everyone up I don't know what will.

We've told legislators and CMS that we save the Medicare program because our equipment and services prevent emergency room visits. Instead of telling them that, maybe it's time to demonstrate that.

Before everyone gets hysterical and reads more into what I'm saying than is actually there, I'm not advocating harm to patients in any way. The patients are, unfortunately, the innocent victims in the games that CMS plays and our responses to the agency, just as so many of us are the innocent victims of the people who have committed fraud in the industry.

We can handle a strike responsibly. We can inform our patients ahead of time (stressing why we're doing it and that we need their support) and tell them what to do and where to go in the event of a need during a strike (but that the industry will be unable to serve them while the strike is going on).

Our patients need us. The Medicare program needs us. We know that. Telling the government that hasn't worked, so it might be time to show them.

The verdict you pronounce upon the source of your livelihood is the verdict you pronounce upon your life. (Ayn Rand)

I don't accept that the verdict of legislators and CMS on this industry is correct or just.

I haven't looked into the legalities of an organized industry strike; I'm not a lawyer. Strikes are obviously legal on some level; airline pilots, teachers, postal workers, auto workers, and other professionals from other industries have gone on strike. If a union is required to facilitate a strike, then perhaps it's time for the industry to form a union (AAHomecare and Rob Brant need not apply for union leadership, thanks).

I've heard others in the industry make flippant comments about how we should all go on strike, but talking isn't doing, and we need action, not words. Yes, there will be those greedy souls who will try to take advantage of a strike by crossing the figurative picket lines and doing business anyhow. But if enough of us -- most of us -- follow through and flex our collective muscle, we might manage to send a strong message that will give us more bargaining power.

It's Time For a 300
In bowling, strikes are good. This can be true of strikes in industry as well. It's all in how we do what we do, and we need to do something more than what we've been doing.

We need to bowl a 300 if we're going to save the industry. Lucky strike, anyone?

Ready For Your Close-up, Chicken Little?

This just in: The sky is not falling.

I expected to see stories in the industry press about how the predications about the competitive bidding program are coming true, but this morning's article in HomeCare Monday is just silly.

If you learn one thing from having lived through decades of changing views, it is that all predictions are necessarily false. (M. H. Abrams)

Never make predictions, especially about the future. (Casey Stengel)

I anticipated that there would be problems with and complaints about competitive bidding once it was implemented. Any change on this scale is going to be accompanied by tribulations and grievances. For that matter, change on virtually any scale meets with grumbling.

The re-tooled round one of competitive bidding for DME was implemented on January 1, which was a Saturday. Today is January 10. Competitive bidding has been "live" in the round-one CBAs for a mere nine days (not counting today).

HomeCare Monday tells the industry that Michael Reinemer, of the AAHomecare staff, said that the "complaints" received have run as follows:

1. Patient confusion or dissatisfaction about the need to switch HME providers.
Is this really unexpected? A patient who is comfortable with a current provider won't want to switch. A patient with a pair of shoes that are comfortable because they're broken in won't necessarily welcome a new pair of shoes. People are creatures of habit.

2. Delayed discharge from facilities.
What kind of "delays" in discharges are we talking about here? This "problem" is too vague.

3. Admission to a hospital because of no access to HME.
I'm as opposed to competitive bidding as anyone else in the industry, but this "problem" is one I find damn hard to believe.

There is access to HME in the bid areas. Is it reduced? Yes. But there are functioning, contract-winning providers in the bid areas. It's simply a matter of locating them.

I'm frankly surprised that contract winners didn't make it their collective business to inform referral sources that they won contracts to ensure referrals during the inevitable implementation confusion. Doing so would have cost time, effort, and some money, but would've been a sound investment. I find it almost impossible to believe that this didn't happen.

4. Problems coordinating delivery of items.
If there's confusion about who can provide what, then of course there will be problems with coordinating delivery of items. I'm going to put this one on my "duh" list.

5. Companies laying off employees.
Companies have been laying off employees for the past couple of years; it's a tough economy. I'm sure there are lay-offs that are directly related to the bid, especially for companies that didn't win contracts and/or for companies that elected to not grandfather. But not all lay-offs in the industry are tied to competitive bidding, and to argue that they are is ingenuous.

6. Questions for the CBIC that go unanswered.
Such as?

The HomeCare Monday article goes on to quote AMEPA; here I was hoping that the magazine had raised its source standards. It would appear that my hopes were in vain; AMEPA is not a source I'd view as credible (the opposite is true).

But let's take a look at what AMEPA had to say anyway; I like a good laugh on a Monday morning.

AMEPA is cautioning "its members that they should verify answers to questions about competitive bidding with others because the CBIC was, in some instances, giving conflicting answers. 'Whatever you are told, check with others first to verify because the answer might not be accurate,' AMEPA told members in its newsletter. 'Many consultants believe that the CBIC is being stricter than the rules direct in order to make things run smoother or just to eliminate non bid-awardees quicker.'”

Verify answers to questions with others? And just who are those others who are qualified to answer questions about the bid program?

AMEPA says that "many" unnamed "consultants" believe that the CBIC is trying to make things run more smoothly or to eliminate providers who didn't win contracts more quickly. Interesting. What evidence does AMEPA have to substantiate such a leap? My guess is that it has none. Am I surprised? No. I don't think that AMEPA has anymore interest (or investment) in truth and accuracy than its TAHCS off-shoot organization.

AMEPA's newsletter said that they called dozens of hospitals last week and found that more than one-third had no idea that there was a bidding program. I suppose that could be true, depending on the people with whom AMEPA spoke. But considering all that's been written about the DMEPOS competitive bidding program, and considering all the alerts that CMS has sent out, I'm a bit skeptical about what AMEPA is saying.

Then again, I'm skeptical about anything that AMEPA says, which is why I take nothing that they say seriously.

I might take FAHCS more seriously if Sean Schwinghammer wasn't its executive director; his like role with TAHCS (and AMEPA) have tainted what little credibility I think he might have had (I judge him by the company he keeps, and I make no secret of what I think of TAHCS and AMEPA).

I will admit, however, that what he is quoted as saying about Jackson Memorial Hospital makes a certain amount of sense. If it's true, it's not fair to small businesses. But the hospital probably doesn't have an obligation to small businesses, and its (alleged) policy fosters internal efficiency, which is a sound business practice.

The "leaders" of the industry have been predicting that competitive bidding will fail.

Social Security has been effective for 70 years; prior predictions of its demise have been totally overstated. (Grace Napolitano)

One of the things that I think we have learned is that we should all be very careful about making predictions about the future. (Bill Clinton)

The thing this industry needs to be careful of is taking what data it collects and skewing it to give competitive bidding a greater appearance of failure than it actually has. Nothing will undermine the industry's credibility more than exaggeration.

Exaggeration is a blood relation to falsehood and nearly as blamable. (Hosea Ballou)

Exaggeration is to paint a snake and add legs. (Anonymous)

If anyone out there thought that the implementation of competitive bidding would go smoothly, I have a north-pole resort I'd like to sell you. Change creates confusion. So in this, the start of executing the program, problems and complaints are to be expected. It's too soon to yell that the sky is falling. The industry's predication of failure of the program will be borne out if (or when) the problems and complaints don't stop.

Anyone For a Piggyback Ride?
AAHomecare has come out with an idea that the association knows won't work.

Typical.

An HME News article dated November 7 says that AAHomecare sent letters to "leaders" in the House that asks them to include a repeal of competitive bidding in H.R. 2, which is the bill in the House meant to repeal the health care reform law.

In the very next paragraph, AAHomecare acknowledges that if the tactic is successful in the House, it's not going to be supported in the Senate, and so the gesture is nothing more than a "political statement."

Which makes the whole thing absolutely pointless.

Political posturing infuriates me. The industry's "voice in Washington" needs to do far better than to offer nothing more than a worthless political statement.

If this is what they're doing to justify the dues they charge, they need to go back to the drawing board.

The article goes on to say that "Stakeholders plan to fuel efforts to repeal or modify competitive bidding by collecting reports of problems." Reinemer is quoted as saying that "I think the Republicans' challenge for repealing or replacing the health reform law is an apt analogy for our challenge for stopping or modifying competitive bidding, and we may be able to piggyback on their legislative proposals."

Yeah. Those legislative proposals that aren't going to be successful. That's strategy at its finest. Piggybacking on failure is always a win.

Your "voice in Washington" is still beating the "modify competitive bidding drum."

AAHomecare has basically admitted that they don't have the ability to lobby effectively for the industry. They haven't said it as clearly as I have, but the proof is in the results. Has competitive bidding been repealed? No. Is the industry, as led by AAHomecare, any closer to getting competitive bidding repealed? No. The only reasonable conclusion that one can draw from that is that our "voice in Washington" may as well be mute for all the good it's done.

A modified competitive bidding program is still competitive bidding. Competitive bidding in any form will still put small businesses out of business. Competitive bidding in any form will still result in problems for patients and contract winners.

Modification isn't acceptable; modification is rolling over and playing dead. Modification is selling out. It's surrender.

Strength does not come from winning. Your struggles develop your strengths. When you go through hardships and decide not to surrender, that is strength. (Arnold Schwarzenegger)

We cannot, we will not, choose the path of surrender. (Woodrow Wilson)

Seth Johnson has the right of it. Round 2 must be slowed. It makes no sense for another round to be implemented until the first one has run for a while and the problems associated are documented and successfully addressed.

Wayne Stanfield chimes in with the need for a rewrite of the DME benefit; apparently his goal is to have the "services" that the industry provides recognized.

During the campaigns against competitive bidding, I was told in alerts to stress the "service component" of the industry. The problem is that I'm not sure what that is.

DMEs deliver to patients. That's a service.

Some DMEs offer resperatory therapy via therapists. That's a service, but only if it's offered to patients. I consider it a "conditional" service.

Some DMEs have O&P fitters who relate to the products they offer to patients. So that too is a service, but only if it's offered; I'm putting this one in my "conditional service" list as well.

I don't consider billing Medicare and other payors as a service, because it's a cost of doing business. Sales staff that I may employ don't offer "services" to patients, and is also a cost of doing business. Ditto administrative and support staff.

What, Mr. Stanfield, are the "services" we want to have recognized? I've always wondered about that, but have hesitated to ask, because when it's been discussed at events, the others around me nod wisely about stressing the importance of the "services" we provide, and I don't want to appear, well, stupid.

So please, Mr. Stanfield, be specific about the services that CMS and congress grossly undervalue and that deserve recognition.

All my life, I always wanted to be somebody. Now I see that I should have been more specific. (Lily Tomlin)

I went to a general store but they wouldn't let me buy anything specific. (Stephen Wright)

You cannot make it as a wandering generality. You must become a meaningful specific. (Zig Ziglar)

Applause Applause
HME News deserves praise for not mentioning AMEPA, TAHCS, or FAHCS in the article I've cited in today's blog. It's a step in the right direction.