CMS: Knock it off with the hubris

Thursday, October 28, 2010

If you missed the recent Associated Press story about a generation of nincompoops, e-mail me.

It's about otherwise bright children who are unable to tie their shoes or use electric can openers or ice cube trays because technology or their helicopter parents do all the tasks that used to be considered life skills.

I would lump the individuals who came up with the competitive bidding scheme together in the nincompoop category.

That can be the only explanation for the statements made by the gray-suited bureaucrats at the recent House Energy and Commerce's Subcommittee on Health Care hearing. In spite of its length (nearly three hours), it's worth watching because the subcommittee didn't buy the bureaucrats' testimony. They kept asking pointed questions. It also provided proof of the nincompoopery exhibited by those in charge of competitive bidding.

The phrase "We will have processes in place to ensure access and quality" was repeated several times. How long have HME providers been listening to that? Will have? When? Did you know that the program starts Jan. 1 in nine cities and will be rolled out to 91 more in 2012?

Or, "We have resources in place to deal with problems as they arise." Since when? Since Operation Wheeler Dealer? Since the "60 Minutes" piece on fraud in South Florida? Could you recognize a fraudulent claim if it jumped in your lap and called you "Mama"? Of course not, which is why you've penalized an entire industry for "fraud and abuse" when it is your agency's job to weed out scam artists and con men. Yet you keep paying their bad claims year after year.

And, "We haven't seen a suicide bid." How would you know? Did you consult people who actually understand auctions and bidding when you were devising this very flawed scheme? When more than 160 economists agreed you blew it again, (Round 1 Redux) it's time to step back, take a deep breath and contemplate your next career.

Based on the CMS rhetoric that has accompanied this ill-conceived policy all the way back to the Polk County (Florida) demonstration project, the phrase "blind arrogance" comes to mind. It's been damn-the-facts, full-speed-ahead for years. HME is approximately 2% of the Medicare budget, yet it has been the red-headed stepchild since the very beginning, in spite of the fact that it is cost-effective and patient-preferred.

It's not a commodity, despite how many 25-year-old congressional staffers Google "oxygen concentrator" and discover one priced at $39.95 on e-Bay. They could probably find a stethoscope even cheaper, but no one is qualified to use it except a medical professional. No one is qualified to handle a concentrator patient except an HME provider with respiratory expertise. Complex medical equipment needs delivery, setup and service. Users need patient education and continuing support. When the machine breaks down at 3 a.m., they need somebody to call.

(By the way, if you've visited Capitol Hill lately, you may have concluded what several of my colleagues believe: These 25-year-old congressional staffers, only a few years out of college and ignorant about the healthcare system in general because they've never had to use it, are making policy that affects all of us who do need health care. That's a very scary thought.)

VGM analysts have concluded that once competitive bidding is rolled out nationally, up to 100,000 HME jobs could be lost.

All this, just as 77 million baby boomers need health care. For the next 18 years, 10,000 boomers will turn 65 each day. Who's going to be left to provide their medical equipment and services? Who's going to be left to take care of the 20 million Americans who currently use HME if this disaster train keeps rolling down the tracks?

The nincompoops who conceived competitive bidding are accountable to no one. They did not run for office; they dwell in monolithic office buildings out of the public eye, not subject to any open meetings laws. Legislators make nincompoop policies law by putting some really bad ideas into 1,000-page bills at 2 a.m., when nobody is around to question them.

Mark Bauerlein, author of the best-selling book "The Dumbest Generation," told the Associated Press this about nincompoops: "They won't grow up unless you do your job by knocking down their hubris."

And insisting they download apps for common sense. hme

Carolyn Cole, vice president-communications of VGM Group, Inc., is a former newspaper editor and a current member of the Waterloo (Iowa) City Council.