Observation Deck:

Playing to Win the Game

The competitive bidding fight can still be won.

My brother, a Pennsylvania Hall of Fame High School Football Coach, is the epitome of believing in oneself and one’s team. Through thick and thin, winning and losing seasons, he’s never lost his love for the game of ­football or the thrill of helping a youngster attain a full college scholarship.

 If you asked him to state the benefits of playing this brutal collision sport, he’d say it teaches the value of teamwork, the rewards of preparation and develops character in the face of adversity.

Every Friday night the team is tested, the athlete is tested, and the coach is tested. No one quits until the last play is executed. It’s a fight to the end. Sometimes there’s a “Hail Mary” pass and a fairy tale ending, sometimes an interception that abruptly interrupts victory. With its ups and downs, its successes and its losses, the game of football is a metaphor for life.

What has this got to do with anything in the healthcare industry? Think competitive bidding.

 

A No-Win Game?

Competitive bidding is the most ill conceived program the Centers for ­Medicare and Medicaid Services (CMS) has ever concocted.

CMS introduced a game that can’t be won. And that’s not just my opinion. It’s the opinion of 167 experts in bidding and auction models — including a Nobel Laureate — who hail from prestigious centers of higher learning like Harvard, Yale, Stanford and MIT. The experts have attempted to convey their conclusions to CMS Administrator Berwick, to Congressman Stark, to Chairman Baucus, and to others in Congress, stating they don’t disagree with the auction concept, if built upon solid principles. But this program is not on solid ground. The experts even identified the changes required to make the program hypothetically successful. CMS isn’t listening.

At the time I write this, in a mere six weeks, Medicare beneficiaries in the Pittsburgh Competitive Bidding Area, where our personal business of 75 years is located, will be serviced by providers who, in 58 percent of the mix, are located in other states, actually in other geographic regions of America. Despite CMS press releases to the contrary, they have never provided a product to a Medicare beneficiary in our CBA. It’s questionable if some have ever provided the product for which an award was won.

Our industry has been playing defense for so long, it’s difficult to call the right offensive play. We’re searching the playbook for the route that will for once and for all put this illogical program to rest. It’s the fourth quarter with only minutes remaining, but no one is hanging his or her head dejected at the impending loss. What does that say about our industry? Volumes.

The mid-term elections that rehashed President Obama’s enacted policies like the Affordable Care Act, TARP 2 and the Stimulus Bill took down the Democratic majority in the House, including Rep. Kendrick Meek (D.-Fla.) who ran for a Senate seat in Florida and introduced H.R. 3790 as a congressman. And the Ways and Means Health Subcommittee Hearing originally slated for mid November is unlikely to occur in a lame duck environment. Where do we go from here?

Only an Administrative Delay would prevent Competitive Bidding from initiating without requiring a pay for by the industry.   That may demand compromise in the form of a redesigned Competitive Bidding program at a later date.  It  doesn’t preclude our ability to continue our fight to repeal the program once the  112th Congress starts work in January.

Some might say our industry has been floundering to find its voice over the past three or four years or that our industry is fragmented. Some might say that the horse is out of the barn, and that we never had a chance of stopping competitive bidding or that we never possessed the lobbying power to make things really happen on Capitol Hill. I disagree. I see a field of players who are tough, tenacious, ethical, and compassionate, creative and who are huddling to call that last play that finally stops the opposition in their tracks.

 

A Difficult, Rewarding Journey

My brother has told his teams over the years that adversity builds character, and that when character prevails, it defines success. Our industry has character! And, if I sound philosophical, that’s my intent.

In our professional and personal lives, we are confronted with terrible illnesses and traumatic situations. Often, the journey that ensues is more meaningful than the ultimate goal. The journey that pulls family and friends together to help a loved one in need, that teaches us to live each day to its fullest, that reminds us to attain peace in little things, and to give one’s very best, is the lasting lesson. Adversity does change us for the better.

Adversity has forced our industry to raise our bar not only in terms of how we run our businesses, but how we advocate on behalf of our industry and our patients. I see real team effort and determination among HME providers. The fight to stop Competitive Bidding has made us better providers and better advocates. I’m proud to be part of this team, proud that we found our voice and stretched our comfort zones. There’s something inherently powerful when considered to be the underdog and knowing we are right.

If we don’t secure an Administrative Delay,  Jan. 1, 2011 takes our game with CMS into overtime — the battle to stop competitive bidding certainly isn’t over. Moreover, we will stop this ill-conceived program. I believe we will succeed because competitive bidding is fatally flawed and is unsustainable, and that will become resoundingly self-evident to lawmakers once the system starts breaking down.

CMS may appear to have a win in their pocket. But, this game is on our playing field, and eventually CMS’s game plan will result in ineffective patient care, lack of quality, reduced patient access to the right DME, and resulting higher costs for Medicare. At that point, a time out will be called.

And that will be out point to stop the competitive biding program before it hurts any more patients or providers. So, be ready to catch the “Hail Mary” pass when it’s thrown our way, and head for the end zone!

This article originally appeared in the December 2010 issue of HME Business.

About the Author

Georgie Blackburn is vice president of Government Relations and Legislative Affairs for Pennsylvania-based provider BLACKBURN’S. She can be reached at georgie.blackburn@blackburnsmed.com.


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