Scoundrels and gunslingers

Saturday, May 31, 2008

Have you seen “Deadwood,” the critically acclaimed HBO show named after a South Dakota boomtown in the 1870s? The show’s characters raise swearing to a high art, and a few are as likely to cut your throat as a deck of cards.

It’s a world full of drunks (Calamity Jane), prostitutes (Trixie), gunslingers (Wild Bill Hickok), miners, Indians, government officials, robber barons (George Hearst) a prim-and-proper school teacher, honest shopkeepers (Sol Star), henchmen, scoundrels (Al Swearengen), a hot-tempered lawman (Seth Bullock) and all sorts of other characters looking to strike it rich or carve out a new life for themselves in the American West.

I bring up Deadwood because on more than one occasion someone has compared factions of the HME industry to the Wild West. I see their point. We’re not operating in the free-for-all that was Deadwood before “the law” came to town, but HME is in a period of evolution. There are all kinds of issues (competitive bidding, the 36-month oxygen cap, Internet sales, home sleep tests, fraud and abuse, etc.), and how they resolve themselves remains to be seen. But rest assured, resolve they will.

Mark D’Angelo, vice president and general manager for sleep therapy at Respironics, said recently that “success in the sleep market tomorrow will look different than success today.”

D’Angelo was talking about sleep, but you can just as easily apply his words to nearly any segment of the home medical equipment market.

I’m no fan of competitive bidding, which is a terribly flawed and bureaucratic boondoggle, but the extreme changes it calls for can’t help but force providers to think about running their businesses differently. By differently, I mean more efficiently, more creatively. Even if the industry succeeds in derailing competitive bidding, reimbursement is still going down, and providers, to succeed, will have to change how they operate.

Eventually, the dust from all these changes will settle, and the HME stagecoach will pull into town. That town won’t be Deadwood, circa 1870.

There will still be some tough characters, but you won’t have to watch your back at every turn. Given the challenges that seem to lurk in ambush around every corner these days, you may take a beating on the way to town, but if you do what’s necessary to pull through, you’ll have plenty of time to heal your bumps and bruises.