CMS's 'smarmy sleight of hand'

Saturday, September 30, 2006

It's hard to believe that CMS put forth its latest mandate with a straight face. As reported in the Aug. 28 HME NewsWire, Medicare withheld nine days worth of payments in September to shift costs to the next fiscal year, which began Oct. 1. According to the story, no interest accrued and no penalties were paid on the withheld amounts.
Alan Abelson, in his column in the Aug. 28 issue of Barron's, calls this strategy of cost shifting "smarmy accounting sleight of hand." He goes on to note that this is "just the kind of manipulation, incidentally, that under Sarbanes-Oxley can land a slippery CEO or chief financial officer in the pokey." This should "save" $5.2 billion in the current fiscal year. Of course, it will add $5.2 billion to next.
What is CMS thinking? It's hard enough to make money in this business today, what with constant cuts, the oxygen cap, new PWC codes, etc. Now they're going to withhold payment for nine days, too?
Of course, regardless of payment, business will go on. Patients will need to be serviced. Equipment will have to be delivered. Your staff won't be taking nine days off without pay or deferring their checks until you get paid. And all of this disruption, just to move some charges from one month to the next, in what's a questionable practice at best. Does this mean that at the end of the next fiscal year, when the shortfall is doubled (or worse), that checks stop arriving the first of September? Or the first of August?
It's time the bureaucrats recognized the value and cost of the Medicare program. We know that caring for patients in the home is better for them and keeps costs low. We need factual data to continually reinforce that message to CMS and others on the Hill. Once the true value is known, we can make the case for rewarding cost-effective strategies of care and get the powers that be to stop making HME a target.
By the way, in the meantime, I like Abelson's suggestion:
"We have a modest counterproposal: Why not hold up the paychecks of the people in the upper echelons of the Medicare bureaucracy and the Office of Management and Budget until the $5.2 billion target is reached? It might take more than a year or two. But, hey, they're dedicated public servants, so we're sure they wouldn't mind lending the government money for such a good cause. And, no matter how long it took, they'd be paid in full--but fair's fair, without interest."
Maybe they could start the ball rolling by not replacing Mark McClellan and saving that salary.
Further news on the CMS front: Our Sept. 11 HME NewsWire reported on a letter from eight members of the former Technical Expert Panel, established in February to advise CMS on the development of new power mobility device codes. The letter states: "Many of our most critical recommendations were ignored or modified to the point that they no longer represent our intent as panel members."
This concerned and dedicated group has re-formed and developed a new set of recommendations, detailing the errors made in the final report and providing recommendations for correcting those errors.
We sincerely hope that CMS will pay attention this time rather than looking for a quick rubber stamp to some sort of predetermined policy.