Editor's Note

The Element of Surprise

The industry and CMS are waiting for each other to make the first move.

• By David Kopf
• Feb 01, 2013

You’ve probably never heard of a track stand, but you might have seen one while waiting at a stoplight. A track stand is when a cyclist balances on both wheels, feet on the pedals, but not going anywhere. While it might look like something the cyclist is doing out of boredom, or the need to show off, it actually is a skill that has itsorigins in velodrome tracing.

And doing a track stand is exactly what the industry and the Centers for Medicare andMedicaid Service are doing. Let me explain:

Velodrome racing is fast. The bicycles are geared to reach speeds as high as 45 mph. But oftentimes the racers will actually be standing still, one slightly in front of the other. The reason for this is to take advantage of slipstreaming and the steep,angled walls of the track.

A cyclist riding behind another racer expends considerably less effort — roughly 30 percent — than the one in front. So, in a race, a pursuer can stay behind the leading racer, who is working much harder, and then, at the right moment, swing slightly up on the track, and use the slope and a sudden explosion of effort to shoot past the leader,who won’t have the wind or energy to catch up.

In short, one racer waits for the other to burn himself or herself out and then strikes a coup degrace. Sounds like a great plan, right?

Not exactly. The racer in the lead is wise the pursuer’s plan and won’t relinquish the upper hand quite so easily. Instead, the lead racer slows to a crawl, constantly eyeing the pursuer. Both slow until they are eventually stopped, their feet still clipped and strapped to the pedals, precariously balanced on the sloped track walls. Each dares the other to make the first move and give up the abilityto slipstream.

It’s a lengthy stare down, ultimately broken by a sudden blast of effort. One rider tries to take the other unawares and get so far ahead that the pursuer has no chance of slipstreaming or usingthe track’s slope to an advantage.

Sound Familiar? This is exactly the position inwhich the industry finds itself with CMS.

CMS was supposed to release its Round Two bid amounts in fall. As of this writing, that has yet to happen. The reason for this delay? CMS wants to try and throw off the pay-for for whatever new legislation Rep. Tom Price (R-Ga.) introduces into the House to replace the competitive bidding program with the industry’s market pricing program. (Turn to “News, Trends & Analysis,” page 8, to read more about the state of the industry’sMPP legislation).

The new MPP bill will need to be “scored” by the Congressional Budget Office to ensure that it will be able to pay for itself and not leave Congress with a budgetary hole it needs to fill. So, CMS sits right behind us, waiting for us to make the first move and release that bill. That way, CMS can release Round Two’s bid amounts saying, “not so fast, the bid amounts are lower and throw off the bill’s CBO score.” Just like the pursuer in a track race, CMSthinks we’re not aware of its plan.

And just like the lead racer, we need a plan that will undermine CMS’s strategy. We just might have one: One of the ideas under discussion is to include in the new MPP bill legislative language that says if passed, affected providers will adopt competitive bidding pricing — but not the exclusive contracts — for a period of time to compensate for anypossible budget offset.

This is a solid strategy in my opinion. Lawmakers, through their past support of other legislation, have demonstrated they don’t think competitive bidding is a good program, but they are too budget-conscious to agree to any shortfall. This approach gives legislators the confidence to move forward with any MPP legislation we put in front of them. And meanwhile, CMS will be staring at our rapidly receding back wheel, wondering howit didn’t see that coming.

This article originally appeared in the February 2013 issue of HME Business.