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
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?
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