Somebody is getting busy...

Monday, November 21, 2011

This is a story about four people: Everybody, Somebody, Anybody and Nobody. 

There was an important job to be done and Everybody was sure Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that, because it was Everybody's job. Everybody thought Anybody could do it, but Nobody realized that Everybody wouldn't do it. It ended up that Everybody blamed Somebody when actually Nobody asked Anybody.

I had a card printed with that story on it, and I hand it out when people need to focus on individual responsibility. We are facing serious difficulties in the HME industry, and I thought we could use a refresher course on the universal truth in this adage.

I'm a little tired of the pleas for us to "call our congressman." Most of us realize that calling our congressman is the equivalent of complaining about the weather. We might feel better, but otherwise, it doesn't accomplish much. 

Someone else has probably been calling that same congressman telling him, "We insist that you create an impossibly complicated bidding system to cut at least 70% of the already competitive, skilled and conveniently located HME providers out of the system." Our problems didn't originate with our congressmen, and it looks like they won't be solved by providers talking to them. 

So, most of the HME providers become or stay the "Nobody" in the story. They wait for the axe to fall--deer in the headlights, lambs to the slaughter. Our experience shows that less than one in five providers takes a consistently active role in advocating for reform and support of patient needs. 

Many do support organizations (with membership and dues) that are trying to right the ship. Beyond that is a "thin red line" of effective advocates on the front lines since the drums have begun to roll for our industry (my apologies to Kipling). Here's what's being done right now. They are not waiting for Anybody. 

The Midwest Association of Medical Equipment Suppliers and People for Quality Care spearheaded an August telephonic town hall meeting in the Kansas City bid area. They engaged more than 50,000 households in an interactive discussion of home health issues. A panel of experts, including an equipment user with disabilities, took questions from beneficiaries. 

Town hall meeting participants were beneficiaries and most importantly, voters. They asked questions, reported problems and were immediately connected with their congressional representatives. Their information was collected automatically for follow-up correspondence. Hopefully, they will become warriors in our battle with the bureaucracy and Congress. HME providers in the bid area helped by gathering volunteer patients to participate and relate problems with the new system. There are immediate plans to expand this to other bid areas. 

Kelly Turner and Beth Cox, both of P4QC, have been traveling the country, videotaping real beneficiaries who have real-life concerns about what competitive bidding will do to their lives. Check out www. and Contact them at 1-800-260-7913 to join the effort.

The Center for Regulatory Effectiveness, a Washington, D.C.- based investigative and advocacy group, had Multinational Legal Services, CRE's legal affiliate, act as counsel to a home medical equipment trade association and an oxygen supply company in a VGM Member-supported lawsuit (through member contributions to Last Chance for Patients Choice) against CMS for 1) not conducting a notice-and-comment rulemaking on the agency's financial qualification standards; and 2) failing to disclose the standards at all.

DME suppliers are required to meet unstated standards for bids to even be considered by CMS's competitive bidding program. 

That suit was recently dismissed by the U.S. District Court on the primary basis that CMS and its contractor, as an agent of the sovereign government, cannot be sued even if it is wrong and abusive in its implementation. That decision is now on appeal to the U.S. Court of Appeals.

At VGM we are supporting, encouraging and initiating efforts like these. We believe that current trends will change and that soon, the rage of the HME beneficiary at being relegated to second or cheapest class citizenship in the Medicare world will erupt and Washington, D.C., will have to respond. 

Don't be a Nobody in the fight: There are effective things that can must be done.

Van G. Miller is CEO and founder of The VGM Group, Inc.