Observation Deck

Stopping the CMS Juggernaut

The Medicare steamroller will run over patients as it crushes suppliers.

• By Wayne Stanfield
• Aug 01, 2013

Although few people in important positions can see it, there rarely has been as egregious an abuse of power by a government agency as the blind implementation of the DMEPOS bidding program by the Center for Medicare and Medicaid Services (CMS) in the face of numerous concerns.

Also, rarely has there been as much support in Congress for stopping the mismanaged program, yet there has been limited action because of the government’s failure to use dynamic scoring to show the real cost of this program, and the fact that no bill can pass that hints of a cost to the budget.

What about the human cost? Does no one really care about the beneficiaries or the workers in the home medical equipment sector? If you save $25 billion dollars and one single American dies, is it worth the cost? If the government saves $25 billion, as they claim they will, on the bidding program but spend as much on inpatient and outpatient care, is it really a saving?

Bureaucratic Arrogance

It is inconceivable that so many smart, highly educated people can publicly state that this program is not what CMS claims it to be, yet is goes on. Is that not the epitome of arrogance? In other sectors of business and industry, when experts and stakeholders say there is a problem, most chief executives would take a step back to at least take a second look.

Not CMS. The career bureaucrats, few with an understanding of how DME services are provided, are driven by an uncompromising attitude that government knows best. Isn’t that why we Americans had a revolution a few hundred years ago?

I have tried to explain this odd and complicated bidding program to people outside the healthcare community and every time they are both astounded and confused. They are astounded that our government can be so blind as to implement a program that makes no sense to anyone. And they are confused as to why we stay in an industry with such a high risk of big brother taking all of our hard earned money back.

On July 1, the DME industry as we know it profoundly changed, and there is little chance of changing it back before harm is done. How much harm, we don’t know. Maybe CMS has it right about costs, but if they are, then surely there is a way to adjust them without destroying a huge number of small businesses, disrupting the lives of millions of people who rely on medical equipment and services in their homes, and putting at risk the jobs of tens of thousands of DME employees trying to make an honest living.

I am disappointed in my government. I am disappointed that people in positions of trust and authority seem so blind to reality that making their point is more important than safeguarding the lives with which they are entrusted. Never has Washington been as broken as in its handling of this bidding program.

If the predictions of those who believe this program is fatally flawed are right, then many thousands of patients needing products and services from DME providers will pay a heavy cost. On the other hand, if the claims of CMS are right, then patients will be just fine, and we deserve what we get since there were too many suppliers, getting paid too much, and stealing from taxpayers to get rich.

Providers Must Fight

If you believe the latter, please, by all means, continue to do nothing. But if you believe that we are right, then now is the time to fight back harder than we have ever fought in our history. Regardless of what transpires between July 1 and when you read this, quitting now and giving up the fight is last thing DME providers should do. This fight is far from over.

Two of the founding fathers of this country said it clearer than I ever could. Thomas Jefferson said, “All tyranny needs to gain a foothold is for people of good conscience to remain silent.” James Madison said, “The essence of government is power, and power, lodged as it must be in human hands, will ever be liable for abuse.” Because Round Two has started doesn’t mean it’s a done deal. We must not remain silent and we must not condone abuse of power. Call (202) 224-3121 and tell Congress your story.

At this point in Round Two, our complaints reporting process has logged more than 400 beneficiary and provider complaints. This means patients are feeling the pain of the fl awed program. Providers are also feeling the pain and the single biggest complaint from within the industry is the failure or refusal of contracted suppliers to honor their obligations under the contract.

Our effort to stop Round Two and replace the current program with something better are in full swing, so as you make your calls to Washington or your local legislator offices, every industry stakeholder is in the trenches with you. State associations are pressing members to report problems and call Congress. On the national level, The American Association for Homecare, VGM Group, The MED Group, NASL, NHIA, NAHC, NCPA, AVAMED, and others are also pushing the message to Congress to act to protect beneficiary access to quality care. Manufacturers and distributors, consultants and attorneys are also engaged to let Congress know the problems with the program. As state organizations and individual suppliers work at the district level, the organizations listed above are working in Washington to reinforce the message that this program is bad public policy and needs to be fixed.

Again I urge every reader of this article to step up and get involved. We will never, never, never give up!

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