Conundrums and Conflicts

I've had some feedback on my last blog. I'm always appreciative of the dialogues that I have with readers; the back-and-forth is invariably productive, thoughtful, and intelligent. My readers and I may not always agree on all points, but communication is the doorway to understanding.

Any fool can criticize, condemn, and complain but it takes character and self control to be understanding and forgiving. (Dale Carnegie)

No, this isn't going to be a feel-good blog; I'm not going "soft" on you.

Tell me and I'll forget; show me and I may remember; involve me and I'll understand. (Chinese Proverb)

There is a great difference between knowing and understanding; you can know a lot about something and not really understand it. (Charles F. Kettering)

Conundrums
I'm using the word "conundrum" as a synonym for "enigma." Here is the definition so you can view the word in context: A conundrum is a paradoxical, insoluble, or difficult problem; a dilemma.

It may well be doubted whether human ingenuity can construct an enigma ... which human ingenuity may not, by proper application, resolve. (Edgar Allan Poe)

It seems to me that when Mr. Poe said that, he wasn't taking government into consideration.

Competitive bidding is this industry's biggest conundrum. I don't think it's a problem that's impossible to solve, but I do think it's going to take greater efforts and better tactics than we've used for the last decade.

I've written a few times that the definition of insanity is doing the same thing over and over again and expecting different results. That definition wasn't lost on one of my readers, who pointed to AAHomecare's new attempt to get a bid-program repeal bill introduced as somewhat insane.

Deja vu!

The latest AAHomecare-inspired bill doesn't stand a chance, and here's why: I'm told by several sources that there is no pay-for in it. If this is true, who's going to touch it?

Bear in mind that I haven't seen the bill, so I can't confirm if what I've been told is correct. But when I have more than one person telling me the exact same thing, I have to move forward on the premise that they're giving me factual information.

The government is working on slashing budgets; our deficit is ridiculous. If what AAHomecare is offering in exchange for repeal doesn't save the program the money it's looking to save, the bill is useless.

As I said in my last blog, AAHomecare has two task forces "working on how to deal with competitive bidding." One task force is "working on a plan to repeal the program and replace it with some other cost-saving measure," and the other is "working on a plan to redesign the existing program to make it more fair."

Task forces are an "action" way to say committee.

A committee is a group of the unprepared, appointed by the unwilling to do the unnecessary. (Fred Allen)

A committee is a group that keeps minutes and loses hours. (Milton Berle)

A committee is an animal with four back legs. (John le Carre)

Here's what I think: AAHomecare has excellent -- and convenient -- timing. It's just amazing how they've timed their "legislative effort" announcement to coincide with their legislative conference. The bill they're supposed to be working on won't be ready for the lobbying they want you to do, but have faith, it'll appear soon.

I don't believe that AAHomecare is serious about repealing competitive bidding. I think that organization's focus is on trying to redesign the program to "make it more fair" (whatever that means). Their noise about a bill is just that: noise. AAHomecare really had no choice; most of the industry is very much against "redesigning" the program, and no doubt the association felt the backlash.

The village idiot would've figured out that that plan would be unpopular before it became public knowledge and would probably have had second thoughts about it before letting it out of the gate.

I think the AAHomecare bill is pointless, and I think AAHomecare knows it. I think this tactic is about damage control, not productivity. I think the bill is about appearances; if the industry thinks that AAHomecare is going to actually fight for repeal, AAHomecare's legislative conference might attract more attendees (which will have a positive impact on what the association makes on the event).

One of my readers told me that "if all who went to D.C. for this no-gain conference [just] wrote a check for [a fraction of] the cost of the trip ... probably $400, and met with them (legislators) [in district offices], we might just make some friends."

I agree. In contributing a few hundred dollars to a legislator, you buy some influence. You'd also save quite a bit of money by approaching the problem with this method than with an expensive lobbying trip to D.C. that will achieve absolutely nothing.

You can go, you can spend time with an aide, and once you've walked out that door, you're forgotten. Yes, the aide took notes, and made appropriate-if-noncommittal noises at you. Yes, you got a certain amount of consideration because you're a constituent (or because you represent a group of constituents). But once the election is over, the legislator's need for you is over until he or she runs for re-election.

If you're a contributor, however, you'll be taken more seriously; after all, if you contribute once, you might do so again, and your checkbook is a good motivator.

Cynical? No. It's how politics works.

It's your money, and you have to decide how important it is to spend it in such a way that you get something out of spending it.

Conflicts
It's occurred to me that people who own or represent DME companies, and who have won contracts in the bid areas, should not sit on the boards of DME associations that are actively fighting to repeal the program.

It's about a conflict of interests and ethics.

I understand that those who participated in the bid process did so to stay in business. I really do get that. But participation implies consent just as effectively as silence does.

It's all well and good to say that you don't want competitive bidding and that you want to see it repealed, but if you came out of the process with a contract (or contracts), you have nothing to lose by playing both sides.

Those who didn't win contracts, however, have almost everything to lose.

Having gone through the bid process and come out a "winner," there is a reason to hope that the program stays in place. Bid winners have a lock on the new beneficiaries who need equipment in the bid categories, and as a result of the program, the competition for those beneficiaries is less than it used to be.

Yes, the reimbursement rates in the bid areas are low, but whose fault is that? The bidders themselves dictated the rates.

This, in my opinion, goes far in explaining the "tweak" strategy of AAHomecare; it serves the interests of the AAHomecare board members who hold contracts. It's a strategy that will benefit the association because it supports those companies most likely to be left standing once the program has been rolled out coast-to-coast.

It raises the specter of a conflict of interest. It's an ethical question. (Roberta Baskin)

I have formed the opinion that I have because AAHomecare's agenda is what it is. I don't think there's any deliberate manipulation or deliberate malice involved; I think it's more about survival of the fittest than anything else.

AAHomecare can try to point to its two task forces that have two different purposes to illustrate that my conclusions are incorrect, but when I'm thinking about this, I take into consideration AAHomecare's consistent failure to get results and the fact that the organization developed its "program redesign" strategy well before it announced a continued fight to repeal (an announcement that was motivated by anger from the industry, I suspect).

There needs to be some reform on some industry association boards. The victors cannot objectively represent or work for the interests of the losers. And when the losers suspect the motives of the winners, the faith in the organization in question is eroded. It doesn't matter if the doubt is justified; what matters is that it exists.

The good news is that AAHomecare doesn't appear to have the influence or the credibility to follow through on any strategy it develops. This is good in one way and dire in another; if our "voice in Washington" isn't taken seriously by legislators and CMS, the industry as a whole won't be either.

We are judged by the company we keep.


Events of Interest Closer to Home
The state and regional associations offer conferences and seminars that are informative and closer to home (less expensive to attend, too). Coming up through March are:

SCMESA Meeting: Columbia, SC, February 24
CAMPS Annual Convention, Irvine, CA, March 1 - 2
VADMEC Winter Conference, Richmond, VA, March 8 - 9
MESA All-Star Conference, Dallas, TX, March 15 - 18
JAMES General Meeting, Monroe, NJ, March 22
MAMES Convention and Expo, Omaha, NE, March 24 - 25
TAHC Spring Conference, Franklin, TN, March 27 - 29

If your state doesn't have an organization, or if your state's association doesn't offer opportunities like the ones above, you might want to look into going to one taking place in a nearby state.