The usual feel-good spin has begun.
You Spin Me Right 'Round Baby Right 'Round
I don't mind feeling good; in fact, I'm strongly in favor of it. But what I don't like is when my hopes are raised and then dashed because there's no substance behind the spin that raised them in the first place.
So I'm skeptical, but not unjustly so.
We've all been down the legislative road trying to get competitive bidding repealed. And we've all seen just how successful those efforts were.
I actually get angry when I read articles in the industry press that offer a sunshine-and-kittens take on the latest bill to be introduced in the House of Representatives.
HME News trumpets that it looks like "providers had the luck of the Irish" during AAHomecare's ridiculous legislative conference; the article has Tyler Wilson gushing about how the bill has "infused the conference with excitement" (pardon me while I gag), and one of the bill's authors (Thompson) telling the industry to "put a face" on the issue and "really drive it home."
Hold on a second; I need to gag again.
The latest bill that Tyler Wilson really needs to succeed isn't anything new. Anyone out there who believes that any bill introduced that's meant to repeal competitive bidding and doesn't have some kind of cost to the industry is an idiot. Altmire and Thompson want to use money set aside for other projects that was never spent as a pay-for? I'll believe it when I see it happen, and here's why: There are more pressing things that our government could use that money on. Getting rid of competitive bidding is important, but I can think of several things to spend "spare" money on, and I'm betting that there are others who want to use that money too.
Does our government really have any "spare" money? We have an enormous deficit. Our government cannot and should not continue to spend money it doesn't have. Not even to serve a special interest.
Thompson tells us to put a face on the issues. What does that man think we've been doing since before MMA 2003? Year after year we've marched to the Hill and made the rounds trying to put a face on the issue and to really drive it home. And every year we've failed.
So I looked at what HomeCare Monday had to say about the bill; I'm going to start off by giving them a very black mark for quoting Rob Brant.
Thank you, Rob, for once again pointing out the obvious; the village idiot could figure out that the industry needs to get previous supporters signed on again, and that we need as many of the freshmen Reps as we can get too.
What would we do without you, Rob Brant? And thanks so much, HomeCare Monday, for turning to Brant for yet another vapid quote. I suppose I could be grateful that you didn't quote Tyler Wilson, but the truth is that though I think neither Brant nor Wilson is credible (or useful), Wilson has a tiny bit more standing than Brant.
Where's the Love?
The industry can probably get a decent number of supporters in the House. Unlike Senators, Representatives have districts, and so they have a smaller gene pool of voters to rely on for re-election. Representatives need to be more engaged because they can't pull voters from the whole state.
If this new bill doesn't get support in the Senate, it's as dead as last year's bill. So though AAHomecare, NAIMES, and the industry press are putting a positive spin on the legislation, the fact is that it's probable that we're going to get as far this year as we did last year.
Failure is still failure, and we don't appear to have any friends in the Senate.
One person quoted in HomeCare Monday said that there were 250 at the conference, but there should've been 2,500 there.
That may be true, but that conference is expensive, and in the end, it has never led the industry to any kind of victory. Yes, it's an event that has one portion designed to get attendees on the Hill to lobby. But where has that lobbying gotten us? Who among us can really afford to invest in something that offers no return? I see AAHomecare's legislative conference as a cash cow for the association. I've attended it, and I've lobbied during it, and nothing has changed.
So if AAHomecare isn't "feeling the love" through event attendance, it has only itself to blame.
The Warrior
I concede that the current effort has to be made. I do not, however, have any faith in our industry "leaders" to steer it to a successful end. It's their pesky track record, you see, that makes me look at them with a complete lack of confidence.
Giving feel-good, rah-rah snippets doesn't make me enthusiastic about our chances, because I see this maneuver as a rerun of previous identical maneuvers. I see this as doing the same thing over again and expecting different results.
As far as I can tell, AAHomecare still has no "hand" in D.C. I continue to see posers (I'm talking to you, Rob Brant) trying to appear worthy and intelligent (good luck with that). And I see too many state association leaders still mindlessly following and publicly supporting the agenda of AAHomecare; the one that's let us down again and again and again.
I prefer more backbone and more independent thinking in my state (or regional) association leaders, but it would appear that that is a very rare commodity. There are one or two out there who don't have the flock-of-sheep mentality (I've heard from some of its members that MESA has no problem telling AAHomecare what it thinks, and if that's true I wish it was a virus that others would catch), and at the end of the day, the members of the associations suffer from the failure of state leadership to take a stand and demand accountability of the ones presuming to lead in the national arena.
It's not true that a bad leader is better than no leader. We've had a decade of bad leadership, and the proof of that is where we find ourselves today. We need a warrior.
Under Pressure
"These are the days it never rains but it pours." We have to give ourselves one more chance, because to do nothing is to give up. But to do the same thing we did before -- and that resulted in failure -- isn't going to do the job. We need a Plan Z, and we need it fast. We shouldn't rely on just one action initiated by flawed leadership, or we'll waste yet another chance.
Like we can afford that.
Tuesday, March 22, 2011
Monday, March 14, 2011
The Blind Leading the Blind Times Two
Over the weekend someone forwarded an E-mail to me that urged providers to attend a "mock auction" that an economist, Peter Cramton, is holding.
NAIMES has been asking people to go, telling them that it's urgent because "it may be the only chance we have to show that an auction will not work for healthcare. We must be there to share the variables and help Cramton understand the DME industry."
Really?
Cramton isn't going to do this to show that an auction that he favors won't work. He's wanting to do a demonstration of how competitive bidding can work. This mock auction isn't a forum for DME providers to make themselves heard; with all the lobbying that's been done over the last eight-plus years, we've had a ridiculous number of opportunities to say what we've had to say.
There is a difference between not being heard and not being listened to.
Cramton thinks he can show CMS a better way to do bidding. He is not telling CMS that bidding won't work for healthcare. DME providers attending this farce are sending one message and one message only, and that's that the industry supports Cramton's take on bidding.
Readers, if CMS was truly interested in what providers had to say, the agency would've been more responsive to us. Round one has rolled out, and CMS is telling everyone what a great program it is. If CMS is showing interest in Cramton's mock auction, they're doing so not to support a repeal, but to get ideas for future rounds.
One state association leader calls Cramton's work "too important to ignore."
Huh?
Cramton's work is only "important" in that its premise is that the current program won't work as is. And that's where the "importance" of the work ends. Cramton is not our industry's champion; he's out to prove that his version of bidding is better.
Do you support that? I don't. I want competitive bidding repealed, not retooled. The mock auction is not about making ourselves heard, and it's not about making CMS rethink competitive bidding. Industry providers and industry "leaders" can attend this event and make noise when they don't like something, but that's not going to change the focus of the event and it's not going to give us any advantage.
One "leader" said something about the mock auction being an opportunity to have a "discussion."It's not an industry-designed or industry-hosted event. It's an event that people are expected to pay to attend (at $80.00 per person, which no doubt goes into Mr. Cramton's pocket; it's nice of us to line the pockets of a man who wants to teach CMS to build a stronger program) for the privilege of seeing an economist tell CMS how to continue to make it impossible for us to do business.
A discussion? I won't name the "state leader" who came up with that bit of brilliance (this time). But considering how often the individual in question waffles and sucks up to AAHomecare, I guess I'm not surprised. Disappointed, but not surprised. He should be ashamed.
I think that any right-thinking person should boycott this and focus on telling legislators that we are opposed to the continuation of competitive bidding in any form; even that of Peter Cramton.
And I think that any industry "leader" who supports Cramton should be a leader no more.
Speaking of Leaders ...
AAHomecare is doing what it's always done but has never gotten results from.
I've always defined insanity as doing the same thing over and over again but expecting different results.
AAHomecare has persuaded yet another Representative to introduce what's being called a "budget-neutral" bill that will repeal competitive bidding.
Deja vu!!
How many of the past bills to repeal the program have been successful? I can count them on the toes of one hand.
So those of you who are storming D.C. will be able to ask your Representatives to support the bill. And Tyler Wilson is patting himself on the back, expecting the industry to think that he and AAHomecare are the greatest things since sliced bread.
The last bill, introduced by Meek, got 259 supporters, but never got out of committee and never got a single Senator willing to touch it. AAHomecare is saying that people can now go to legislators and talk about the "real" problems with round one: problems with access, confusion, and extra costs because patients can't be discharged as quickly.
Readers, the program was implemented January 1st. We're now in the middle of March. Did anyone honestly expect that implementation of a program so big would have no hiccups? I read about the "problems" in the industry press and from other industry-sympathetic sources, but I have to ask myself this: Are the number of problems increasing? Are they decreasing?
In the long run, competitive bidding will save the Medicare program and beneficiaries money. Lower reimbursements mean lower co-pays, and so seniors aren't shelling out as much if they don't have co-pay coverage.
I don't see how any bill that repeals competitive bidding can begin to be "budget-neutral," and fully expect that the score the legislation will receive will show that my skepticism is right, unless the intent is to slash reimbursements as the pay-for. I don't know about you, but my rising costs of doing business don't allow me to continue to do business by making less money.
I won't need competitive bidding in my area to put me out of business if the already-low reimbursements are cut even more. That's the harsh reality of DME, and people who have no experience running a DME (I'm talking to you, Tyler Wilson) shouldn't be making promises and deals on my behalf that I'm very sure I can't afford. People who answer to boards ruled by big companies with far deeper pockets than I have just don't have a firm grip on the difficulties of running a small industry business, and I'm not interested in following those types (I'm still talking to you, Tyler Wilson).
Do I want to see competitive bidding repealed? Yes. Do I think that AAHomecare's latest attempt at a bill will succeed? No. AAHomecare has handed the industry failure after failure, and I don't see that they've done anything new that's going to change the association's losing streak. I think they're ineffective, and history bears out my judgment.
Too Many Problems and No Solutions
AAHomecare isn't the answer; Peter Cramton and his "mock auction" isn't the answer. I'm going to try to ignore Tyler Wilson and his "go me" posturing; I recognize a bunch of hot air when I hear it.
I'm absolutely boycotting Cramton's event, because I don't want my presence to be construed as supporting a revised method of bidding that might actually work.
I want to serve my patients and earn an honest living. I know that I have to be involved to get rid of competitive bidding, but I'm not interested in doing the same things over and over again and expecting different results. I don't know what the solution is, but I know what -- and who -- hasn't worked, and I don't think it's unreasonable of me to think what I do.
What troubles me are the people who will believe in yet another bill and who will believe that they're going to "be heard" at Cramton's event, and that things will change as a result.
I don't like being let down, and so I choose to travel the road of realism. I don't put my faith in false prophets.
NAIMES has been asking people to go, telling them that it's urgent because "it may be the only chance we have to show that an auction will not work for healthcare. We must be there to share the variables and help Cramton understand the DME industry."
Really?
Cramton isn't going to do this to show that an auction that he favors won't work. He's wanting to do a demonstration of how competitive bidding can work. This mock auction isn't a forum for DME providers to make themselves heard; with all the lobbying that's been done over the last eight-plus years, we've had a ridiculous number of opportunities to say what we've had to say.
There is a difference between not being heard and not being listened to.
Cramton thinks he can show CMS a better way to do bidding. He is not telling CMS that bidding won't work for healthcare. DME providers attending this farce are sending one message and one message only, and that's that the industry supports Cramton's take on bidding.
Readers, if CMS was truly interested in what providers had to say, the agency would've been more responsive to us. Round one has rolled out, and CMS is telling everyone what a great program it is. If CMS is showing interest in Cramton's mock auction, they're doing so not to support a repeal, but to get ideas for future rounds.
One state association leader calls Cramton's work "too important to ignore."
Huh?
Cramton's work is only "important" in that its premise is that the current program won't work as is. And that's where the "importance" of the work ends. Cramton is not our industry's champion; he's out to prove that his version of bidding is better.
Do you support that? I don't. I want competitive bidding repealed, not retooled. The mock auction is not about making ourselves heard, and it's not about making CMS rethink competitive bidding. Industry providers and industry "leaders" can attend this event and make noise when they don't like something, but that's not going to change the focus of the event and it's not going to give us any advantage.
One "leader" said something about the mock auction being an opportunity to have a "discussion."It's not an industry-designed or industry-hosted event. It's an event that people are expected to pay to attend (at $80.00 per person, which no doubt goes into Mr. Cramton's pocket; it's nice of us to line the pockets of a man who wants to teach CMS to build a stronger program) for the privilege of seeing an economist tell CMS how to continue to make it impossible for us to do business.
A discussion? I won't name the "state leader" who came up with that bit of brilliance (this time). But considering how often the individual in question waffles and sucks up to AAHomecare, I guess I'm not surprised. Disappointed, but not surprised. He should be ashamed.
I think that any right-thinking person should boycott this and focus on telling legislators that we are opposed to the continuation of competitive bidding in any form; even that of Peter Cramton.
And I think that any industry "leader" who supports Cramton should be a leader no more.
Speaking of Leaders ...
AAHomecare is doing what it's always done but has never gotten results from.
I've always defined insanity as doing the same thing over and over again but expecting different results.
AAHomecare has persuaded yet another Representative to introduce what's being called a "budget-neutral" bill that will repeal competitive bidding.
Deja vu!!
How many of the past bills to repeal the program have been successful? I can count them on the toes of one hand.
So those of you who are storming D.C. will be able to ask your Representatives to support the bill. And Tyler Wilson is patting himself on the back, expecting the industry to think that he and AAHomecare are the greatest things since sliced bread.
The last bill, introduced by Meek, got 259 supporters, but never got out of committee and never got a single Senator willing to touch it. AAHomecare is saying that people can now go to legislators and talk about the "real" problems with round one: problems with access, confusion, and extra costs because patients can't be discharged as quickly.
Readers, the program was implemented January 1st. We're now in the middle of March. Did anyone honestly expect that implementation of a program so big would have no hiccups? I read about the "problems" in the industry press and from other industry-sympathetic sources, but I have to ask myself this: Are the number of problems increasing? Are they decreasing?
In the long run, competitive bidding will save the Medicare program and beneficiaries money. Lower reimbursements mean lower co-pays, and so seniors aren't shelling out as much if they don't have co-pay coverage.
I don't see how any bill that repeals competitive bidding can begin to be "budget-neutral," and fully expect that the score the legislation will receive will show that my skepticism is right, unless the intent is to slash reimbursements as the pay-for. I don't know about you, but my rising costs of doing business don't allow me to continue to do business by making less money.
I won't need competitive bidding in my area to put me out of business if the already-low reimbursements are cut even more. That's the harsh reality of DME, and people who have no experience running a DME (I'm talking to you, Tyler Wilson) shouldn't be making promises and deals on my behalf that I'm very sure I can't afford. People who answer to boards ruled by big companies with far deeper pockets than I have just don't have a firm grip on the difficulties of running a small industry business, and I'm not interested in following those types (I'm still talking to you, Tyler Wilson).
Do I want to see competitive bidding repealed? Yes. Do I think that AAHomecare's latest attempt at a bill will succeed? No. AAHomecare has handed the industry failure after failure, and I don't see that they've done anything new that's going to change the association's losing streak. I think they're ineffective, and history bears out my judgment.
Too Many Problems and No Solutions
AAHomecare isn't the answer; Peter Cramton and his "mock auction" isn't the answer. I'm going to try to ignore Tyler Wilson and his "go me" posturing; I recognize a bunch of hot air when I hear it.
I'm absolutely boycotting Cramton's event, because I don't want my presence to be construed as supporting a revised method of bidding that might actually work.
I want to serve my patients and earn an honest living. I know that I have to be involved to get rid of competitive bidding, but I'm not interested in doing the same things over and over again and expecting different results. I don't know what the solution is, but I know what -- and who -- hasn't worked, and I don't think it's unreasonable of me to think what I do.
What troubles me are the people who will believe in yet another bill and who will believe that they're going to "be heard" at Cramton's event, and that things will change as a result.
I don't like being let down, and so I choose to travel the road of realism. I don't put my faith in false prophets.
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