CMS, false gods and economic theory

Monday, March 31, 2008

I departed AAHomecare’s Legislative Conference last month feeling both elated and frustrated. It’s a strange, contradictory combination of emotions. I felt elated because three economists who spoke at the conference made very strong cases that CMS should not continue with competitive bidding in its current form.I felt frustrated because even when confronted with what can only be considered as pure economic logic, I expect CMS to bull ahead with the ill-fated plan.
Competitive bidding, like some pagan god, has a grip on agency bureaucrats who believe fully in its false promises. That’s why I’ve stopped trying to understand CMS. It’s all a little weird over there. Whether its competitive bidding or combating fraud and abuse, reality seems in short supply. Whatever the problem, it’s always someone else’s fault, and the solution is to cut reimbursement or increase regulatory oversight.
It’s no fun holding people in contempt, but it’s hard to do otherwise when it comes to CMS.
As Sen. Pat Roberts, R-Kan., told AAHomecare attendees, “The folks at CMS are bean counters, trying to turn red beans into black beans. You want to make Medicare fiscally sound, but you don’t want to eliminate the providers who provide the services.”
The economists who spoke at the conference said more or less the same thing. Unlike HME providers and manufacturers, these economists have no agenda. They built their studies on accepted economic theory. They’re looking for the truth, and it’s unlikely they’d compromise their professional standing and future by crafting biased studies that pander to the HME industry.
That’s why when they say that the competitive bidding program for DME stinks—that as concocted it will increase prices and decrease beneficiary access to products and services—CMS should pay attention, at least give it a thoughtful review.
I don’t suspect that will happen. More than likely, if the industry can’t marshal the political pressure to delay competitive bidding for further study, we’re headed for a train wreck. It’s easy for CMS to let the chips fall where they will. Unfortunately, they’re going to fall squarely on the heads of HME providers and Medicare beneficiaries. HME