I've heard and read that "someone should do something" about the situation the industry is in.
Tyler Wilson is quoted in HME News as telling DME providers that they need to get involved.
D-U-H!
This isn't news. The whole article is generic, and could have been written at any time during the last eight or nine years. The industry has been told, over and over again, that every one of us needs to be actively and consistently involved.
There are some gems in this particular article; I was especially amused by Walt Gorski saying that we do have influence over lawmakers, and that "steady pressure over time will crack any rock, and, frankly, steady pressure over time makes diamonds."
That cracks me up.
What does Gorski think we've been doing over the last decade? We've tried the steady pressure approach, and has it worked?
Hint: The answer is only "yes" if we've gotten rid of competitive bidding.
Gorski is also quoted as saying that providers need to be vocal about bidding issues, and that "complaints are going to be what drives this program into the ground."
We've been vocal, for years. And though I agree with Gorski that complaints will be what gets rid of bidding, I don't think that it's complaints from our industry that will do the job. The complaints need to come from the beneficiaries in record numbers.
Cut to Hypothetical Round Robin
DME Provider: Congressman X, I don't like competitive bidding, and it's not good for beneficiaries.
Congressman X: How is it not good for beneficiaries?
DME Provider: It inhibits access to care.
Congressman X: You're a caregiver?
DME Provider: I provide important services in the home to patients.
Congressman X: Such as?
DME Provider: Well, I supply the equipment they need at home, which saves the Medicare program millions of dollars each year because my patients aren't in the hospital.
Congressman X: Medical equipment at home is important, but what services do you provide?
DME Provider: I deliver the equipment to their homes; I also take care of repairs if their equipment needs fixing or maintenance.
Congressman X: Sears delivers and honors warranties too. What services do you provide?
DME Provider: My business is on call 24/7 if a beneficiary has an emergency with his equipment.
Congressman X: Well that's a plus. But I've heard from your national association that your industry provides care in the home, and so far what you're telling me is that you provide medical equipment in the home, but no care.
DME Provider: We do set-up, and teach the patient how to operate the equipment we've delivered.
Congressman X: So does Best Buy.
DME Provider: Sir, our costs of business keep going up, but reimbursements are being slashed. The Medicare program requires that we continue to do business according to specific and costly standards, but it's getting harder and harder to do that in these hard economic times. I need your help, and ask you to support legislation that will repeal competitive bidding.
Congressman X: Competitive bidding for DME is expected to save the government $20 billion dollars. We have a deficit of over $14 trillion dollars. We all have to tighten our belts and find ways to cut everywhere we can. I'm a supporter of small businesses, and understand your concerns. But these are tough times, and entitlement programs have to be trimmed too.
DME Provider: Beneficiaries don't like competitive bidding where it's been implemented.
Congressman X: My district is in a round-one bidding area, and my offices haven't had one complaint from any beneficiaries.
DME Provider: But there have been problems at discharge and a lot of confusion. Medicare didn't educate the public or hospitals or doctors adequately.
Congressman X: My understanding is that these situations have tapered off, and that things are running more smoothly now. Any new program is going to have bumps in the road, especially programs as big as competitive bidding. CMS tells Congress that the competitive bidding is saving money and that beneficiaries are receiving the products they need at better prices. Fraud is also being drastically reduced in the bid areas, and that's going to save the program money too.
DME Provider: Sir, with all due respect, the reimbursements in the bid areas are too low. They're going to drive many of the bid winners out of business.
Congressman X: But the reimbursement rates were arrived at by the amounts providers themselves bid. How can the rates be too low?
DME Provider: We call the people who bid too low in an effort to secure contracts and make up for the low reimbursements in bulk "suicide bidders." CMS didn't do enough to eliminate those bids from the program, and because of that the rates are too low. The agency said that bids too low would be thrown out, but that didn't seem to happen, and now my industry is suffering. CMS should have done a better job.
Congressman X: How is CMS responsible for the unsound bids submitted by the industry's businesses?
DME Provider: CMS should have known those bids were too low and rejected them.
Congressman X: CMS has to work with what it's given. If the agency was given low bids, then the final reimbursements would be low. The responsibility for that lies with the bidders. But let me ask you this: lower reimbursements mean lower co-pays for beneficiaries, don't they?
DME Provider: Yes, beneficiaries have a reduced co-pay for the products and care we provide to them.
Congressman X: What care?
Does that conversation seem ridiculous? It shouldn't, because I've had several like it. Legislators and their aides are always polite and respectful, but if they're familiar with the program, and they have even a vague understanding of the industry, they know what we're going to say before we say it.
Our arguments against bidding are so thin they're almost threadbare.
We can't expect the repeal of a program that is expected to save the government $20 billion, especially if we don't have a pay-for to offer. It's nice of Dean Rosen, yet another lobbyist that AAHomecare is paying, to tell us that we need to be part of the solution (thanks for doing what AAHomecare does best by pointing out the obvious, Dean), but we have nothing to offer because we have no cohesive plan compounded by pathetic leadership.
Round Two Delay
For those of you heartened by the delay, don't be. Though CMS is talking "potential structural changes," the fact is that a "changed" competitive bidding is still competitive bidding. Team Credibility at AAHomecare might be trying to tell us that the delay gives us a chance to get more support for HR 1041, but the truth is the political climate is unfavorable to us, and without big support in the Senate, this year's bill will fail just like last year's bill.
I believe in hope, though it may appear that I don't. But I don't believe in false hope. HR 1041 is, to me, AAHomecare trying to look busy, and I'm not buying into it; I'm smarter than that.
Pity Party
Poor Rob Brant. He's going to close his business at the end of this month.
It's not as though he was that invested in his business lately; Brant had moved to Atlanta. How does one "manage" and nurture a small business in Miami from Atlanta?
Oh, that's right. Brant was more interested in his 15 minutes of annoying those of us in the industry who have taste and who can think on our own.
I've said it before and I'll say it again: If Brant and his cronies, along with a lot of other worthless do-nothings, had gotten involved in the fight before 2008, we might be experiencing a different, more friendly reality today. No, I'm not implying that Brant would have ended up the savior he's made himself out to be; that's a concept that's too ridiculous. But he sat on his hands until it was far too late.
Brant has been abrasive, arrogant, and annoying. He has oozed his way into the limelight, and has managed to smarm himself onto the AAHomecare board. With the closing of his business, he ought to go find something else to do and give the rest of us some peace. He should take Barry Johnson and Dean Cheney with him, too, but we won't get so lucky. My guess is that Brant is going to sell himself as some kind of industry expert and charge for consulting. Or, worse yet, become a lobbyist, which his track record of success would clearly support. Not.
It hurts when I laugh that hard.
Whine and Cheese
When we talk to legislators or aides, we can't make the same pitch we've been making for year and years. We can't sustain the myth that we provide care in the home. If the beneficiaries aren't behind us, we're spinning our wheels. Our strategy needs to be focused on them; our mission is to get them motivated and vocal. We can contact our legislators and storm the Hill all we like; we're not a strong enough lobby on our own. Until the beneficiaries are doing it with us, we're going to go nowhere fast, so that's where we need to focus our efforts. We need to get them good and mad.
Monday, April 18, 2011
Thursday, April 14, 2011
MSNBC Strikes Again
An article on MSNBC today has once again demonstrated the site's genius for pointing out the obvious in an article called "Florida is 'Ground Zero' for Healthcare Fraud."
That's almost as dumb as HomeCare Magazine's tendency to seek out Rob Brant and Barry Johnson for pearls of wisdom they're so obviously ill-equipped to provide.
MSNBC and NBC reporters seem to like doing stories about Medicare fraud in Florida. We all know about the fraud problems in that state; it's a mecca for retirees, so of course there will be more fraud there than, say, Wisconsin. Or Alaska. I think it's fair to say that where there are large number of beneficiaries, the chances that fraud will be committed increase.
It's useless to try to tell the press to use more current statistics, and it's pointless to tell them how our industry is being beaten up by competitive bidding and all the requirements we've been slapped with the last couple of years. The article zooms in on Miami, and rightfully so; Miami has long been notorious for Medicare fraud, and is probably responsible for a large part of the industry's awful reputation. Yes, other cities in other areas have contributed (Houston, for example), but Miami is king when it comes to fraud.
I'll probably get some complaints from Miami providers, but don't wait for an apology. Cliches exist for a reason, and where there's smoke there's fire. I don't know what the fraud stats are for Orlando, but I was completely unsurprised when Miami was in round one of competitive bidding. I think I might have been outraged if it hadn't been.
The article tells us that Medicare systems were set up and run on the assumption that those billing are honest; though the writer points out the flaws in agency staff, those billing are, of course, the bad guys of the story. What's wrong about that is that there are honest people who provide products and submit for reimbursement.
We know that back in the day, being in DME was lucrative, and business owners made a tidy sum from Medicare. But fraud isn't new, and it's taken CMS an incredibly long time to make changes that will enable them to fight the drain more effectively. If a company is billing for an unusual number of, say, left arm prosthetics, and it's not caught, then the system isn't run or policed well.
One the one hand, it's terrible that CMS seems to be able to evade responsibility for not doing more sooner. On the other hand, it's almost tragic that there are people out there actively looking for ways to beat the system and stick it to the taxpayer. The only thing wrong with assuming honesty is overlooking the fact that there's a lot of larceny out there.
Sometimes you can't appeal to a person's better nature because the person in question simply doesn't have a better nature. The entitlement mentality has taken a stranglehold on a huge portion of this country's population, and to those people, getting something for nothing is their right because they think it's owed to them.
When did that happen to us? My parents didn't raise me that way, and I didn't raise my children that way. I appear to be an exception rather than the rule; I can't go anywhere anymore without children running wild and their parents ignoring them or asking them to behave instead of making them act like people instead of animals. During the last twenty years, the trend in parenting has been to be "friends"' with your children instead of parents; we're told to not scar the little darlings by imposing punishment, and making them face consequences for their actions is a shocking idea anymore.
If the government thinks it's having a hard time with fraud now, I shudder to think of what's going to happen as the youngsters in this country come of age.
I'm not saying anything most of you haven't thought privately, but no one talks about it and no one does anything about it. And it's sad, because it's a symptom of the decline of our society and our country.
So there are more investigators on the streets now to combat the fraud problem. The people who go into business to commit fraud know the risks; they're sure they won't get caught, but they know the risks, and I'm guessing that the police don't frighten them because of the lure of a big (and unearned) payday.
It's important to catch the bad guys. But it's more important to fix the system that the bad guys target. CMS has wasted more than a decade doing nothing except pointing the finger at everyone else but the agency staff and agency subcontractors who know a problem exists but do nothing worthwhile to stop it.
I don't see competitive bidding as worthwhile. Deliberately depopulating an industry via a flawed program in the name of reducing fraud is ridiculous. I'm ignoring the "savings" associated with bidding because CMS has always been in control of reimbursement rates; if they wanted to save money, all they had to do was change the fee schedules.
The slant in fraud articles is painfully obvious. There is no more unbiased journalism anymore, and I'm tired of it. Reporters almost always fail to have any meaningful dialogue with anyone in the industry; our side of the story is almost never told. I don't want the press talking with anyone at AAHomecare or, worse yet, Rob Brant and (or) Barry Johnson (or anyone from that group), because they don't accurately or adequately represent DMEs (some of them are actually embarrassing). I don't want to read anymore vapid quotes from the usual suspects; we don't need trite, and we don't need to feed the egos of the hollow who look only to serve their own interests and further their own agendas.
I vaguely recall that AAHomecare had hired a PR firm not too long ago to improve the industry's image. I don't know how much that firm was paid, but I haven't seen a single positive result from that investment; it's yet another failure in a list of failures brought to us by AAHomecare. Our "voice in Washington," which has no credibility on the hill, can't even buy us a better image.
Epic fail, AAHomecare. Again.
I don't know what the answer is. But I'm frustrated, and very sick of being the victim of a smear campaign conducted by CMS and the press. Maybe I'll take action by contacting the MSNBC advertisers and telling them I'll boycott them if they continue to advertise on a site that runs stories that are half-true.
It's somewhere to start.
That's almost as dumb as HomeCare Magazine's tendency to seek out Rob Brant and Barry Johnson for pearls of wisdom they're so obviously ill-equipped to provide.
MSNBC and NBC reporters seem to like doing stories about Medicare fraud in Florida. We all know about the fraud problems in that state; it's a mecca for retirees, so of course there will be more fraud there than, say, Wisconsin. Or Alaska. I think it's fair to say that where there are large number of beneficiaries, the chances that fraud will be committed increase.
It's useless to try to tell the press to use more current statistics, and it's pointless to tell them how our industry is being beaten up by competitive bidding and all the requirements we've been slapped with the last couple of years. The article zooms in on Miami, and rightfully so; Miami has long been notorious for Medicare fraud, and is probably responsible for a large part of the industry's awful reputation. Yes, other cities in other areas have contributed (Houston, for example), but Miami is king when it comes to fraud.
I'll probably get some complaints from Miami providers, but don't wait for an apology. Cliches exist for a reason, and where there's smoke there's fire. I don't know what the fraud stats are for Orlando, but I was completely unsurprised when Miami was in round one of competitive bidding. I think I might have been outraged if it hadn't been.
The article tells us that Medicare systems were set up and run on the assumption that those billing are honest; though the writer points out the flaws in agency staff, those billing are, of course, the bad guys of the story. What's wrong about that is that there are honest people who provide products and submit for reimbursement.
We know that back in the day, being in DME was lucrative, and business owners made a tidy sum from Medicare. But fraud isn't new, and it's taken CMS an incredibly long time to make changes that will enable them to fight the drain more effectively. If a company is billing for an unusual number of, say, left arm prosthetics, and it's not caught, then the system isn't run or policed well.
One the one hand, it's terrible that CMS seems to be able to evade responsibility for not doing more sooner. On the other hand, it's almost tragic that there are people out there actively looking for ways to beat the system and stick it to the taxpayer. The only thing wrong with assuming honesty is overlooking the fact that there's a lot of larceny out there.
Sometimes you can't appeal to a person's better nature because the person in question simply doesn't have a better nature. The entitlement mentality has taken a stranglehold on a huge portion of this country's population, and to those people, getting something for nothing is their right because they think it's owed to them.
When did that happen to us? My parents didn't raise me that way, and I didn't raise my children that way. I appear to be an exception rather than the rule; I can't go anywhere anymore without children running wild and their parents ignoring them or asking them to behave instead of making them act like people instead of animals. During the last twenty years, the trend in parenting has been to be "friends"' with your children instead of parents; we're told to not scar the little darlings by imposing punishment, and making them face consequences for their actions is a shocking idea anymore.
If the government thinks it's having a hard time with fraud now, I shudder to think of what's going to happen as the youngsters in this country come of age.
I'm not saying anything most of you haven't thought privately, but no one talks about it and no one does anything about it. And it's sad, because it's a symptom of the decline of our society and our country.
So there are more investigators on the streets now to combat the fraud problem. The people who go into business to commit fraud know the risks; they're sure they won't get caught, but they know the risks, and I'm guessing that the police don't frighten them because of the lure of a big (and unearned) payday.
It's important to catch the bad guys. But it's more important to fix the system that the bad guys target. CMS has wasted more than a decade doing nothing except pointing the finger at everyone else but the agency staff and agency subcontractors who know a problem exists but do nothing worthwhile to stop it.
I don't see competitive bidding as worthwhile. Deliberately depopulating an industry via a flawed program in the name of reducing fraud is ridiculous. I'm ignoring the "savings" associated with bidding because CMS has always been in control of reimbursement rates; if they wanted to save money, all they had to do was change the fee schedules.
The slant in fraud articles is painfully obvious. There is no more unbiased journalism anymore, and I'm tired of it. Reporters almost always fail to have any meaningful dialogue with anyone in the industry; our side of the story is almost never told. I don't want the press talking with anyone at AAHomecare or, worse yet, Rob Brant and (or) Barry Johnson (or anyone from that group), because they don't accurately or adequately represent DMEs (some of them are actually embarrassing). I don't want to read anymore vapid quotes from the usual suspects; we don't need trite, and we don't need to feed the egos of the hollow who look only to serve their own interests and further their own agendas.
I vaguely recall that AAHomecare had hired a PR firm not too long ago to improve the industry's image. I don't know how much that firm was paid, but I haven't seen a single positive result from that investment; it's yet another failure in a list of failures brought to us by AAHomecare. Our "voice in Washington," which has no credibility on the hill, can't even buy us a better image.
Epic fail, AAHomecare. Again.
I don't know what the answer is. But I'm frustrated, and very sick of being the victim of a smear campaign conducted by CMS and the press. Maybe I'll take action by contacting the MSNBC advertisers and telling them I'll boycott them if they continue to advertise on a site that runs stories that are half-true.
It's somewhere to start.
Subscribe to:
Posts (Atom)