Editor’s Note:

Making the Rules

Consistency and judiciousness mean little when you control the game.

• By David Kopf
• Apr 26, 2012

When I was 11-years-old, we moved from Ohio to sunny California, and at the house next door neighbors lived two boys a little younger than me, who would play soccer in their backyard. Youth soccer hadn’t made its way east to the frozen wastes of Toledo when I was still living there, so being a neophyte to the “beautiful game” I had much to learn about the sport. That said, there was one clear observation I could make about those backyard tournaments: theolder of the two boys was the Pele of cheating.

And I don’t mean he fudged a little here and there. I mean he was outright bamboozling his little brother any chance he could get. The kid behaved as if cheating was some kind of a virtue. He excelled at it. He’d come up with every way imaginable to ensure that his little brother had a thoroughly miserable time, and that he reigned asking of their small suburban pitch.

His favorite technique was to change the rules, or come up with entirely new ones. As soon as his little brother would start to demonstrate some increased skill or knowledge, the older brother would come up with an entirely new way to put him at a disadvantage. And it didn’t matter if his rule changes completely contradicted earlier rules or were entirely arbitrary. In short, he controlled the game from stem to stern and his little brotherhad just as little a say in the matter.

Sound Familiar?

CMS controls the game when it comes to HME, and acts in a similar fashion. Just look at the recent glowing report released by CMS that projects that as Round Two expands under the Affordable Care Act, it could save up to $42.8 billion for taxpayers and beneficiaries over the next 10 years. This followed another report from CMS stating that patients in Round One were experiencing no negative impacts on their access tocare due to the program.

The release of these two reports, and especially the latest one should trouble you. Not just because they are so contradictory to objective reports coming from third-party sources such as University of Maryland economist and auction model expert Peter Cramton, but because of their timing.

Currently the industry is trying to get the Congressional Budget Office to score the market pricing program (MPP) alternative to competitive bidding, because that is the first real step in getting it attached to any legislation in a Congress that is opposed to any additional spending. The MPP has to balance out, and the CBO score would demonstrate that to lawmakers.

So what better a way to make the CBO score that much more difficult to obtain, than by releasing a report that pumps up the amount of Round Two’s savings to the taxpayer? It’s a page ripped from my childhood neighbor’s playbook.

In the same way the older brother would mercilessly rig the games against his little brother, CMS is doing anything it can to ensure it the bid program will winnow down the number of providers it has to deal with.

And what happened to the two soccer-playing brothers? I’d like to say the younger one grew up to join the U.S. national team and would regularly humiliate his older brother, but the truth is they moved, so I really can’t provide a moral, besides this: He kept playing and kept trying to win — and I’d like to think he eventually did.

And that’s the truth of providers’ position in the fight to secure the MPP and see competitive bidding repealed. If you aren’t actively engaged in working on industry advocacy and lobbying on behalf of your business and patients, you will never win the fight against competitive bidding.

You know, I really wish I could remember that soccer kid’s name. I wonder if he works at CMS.

This article originally appeared in the May 2012 issue of HME Business.