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.
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