'We can't save the world'

Monday, November 21, 2011

The week before I sat down to write this editorial, I was on vacation. To say that I felt out of the loop is an understatement, which doesn't bode well for an editor who's trying to come up with a topic for an editorial.

I grumbled about this out loud to Managing Editor Theresa Flaherty. To which she said, "Throw your weight around on MPP." To which I said, "I was hoping I'd never have to do that."

It's a perfectly good topic for an editorial. I mean, what's the most pressing issue in the HME industry right now? It's the prospect of having an ill-designed and harmful competitive bidding program expanded to 91 areas in Round 2. And what has been the most recent development in the industry's efforts to fight the program? It's the market-pricing program (MPP) as an alternative to the current program.

The dilemma: While MPP is chock full of improvements--things like using a clearing price instead of a median price as the single payment amount, and making bids binding--it also includes a provision that would maintain Round 1 until the program is implemented. That's a tough pill to swallow for hundreds of providers in nine areas that have suffered with, on average, 32% less reimbursement for nine product categories for almost a year now. And they face two more years of that hell.

So these are my choices as I see them: I can support MPP and upset providers in Round 1, who feel like sacrificial lambs; or I can withhold my support for MPP and risk throwing away the best bet at redeeming the industry.

Now, nothing's ever this black and white. Some stakeholders believe there are possible compromises that lawmakers might consider. What about replacing the provision to maintain Round 1 with a provision to use clearing prices to re-set the single payment amounts for Round 1, or a provision to shave off the last year of the three-year contracts for Round 1?

These are good ideas, and supporters of MPP say they'll consider them. But they also say lawmakers won't touch Round 1 with a 10-foot pole, not when they were recently charged with reducing the deficit by at least $1.2 trillion, and I believe them. For all intents and purposes, lawmakers have already deposited the savings from Round 1. There are no withdrawals allowed.

At the end of the day, I have to throw my weight behind MPP, even if it means maintaining Round 1 until the program is implemented. The saving grace for providers in Round 1: What they're paid now is not necessarily what they'll be paid in the future. I know there are some providers who won't be able to ride out the next two years, but I'm with the industry stakeholder who recently told HME News: "We can't save the world."

As Fred Nutter, the former editorial director of a local TV news station in Portland, Maine, used to say: "That's our opinion...we welcome yours."



Forget about the world. We can't even save ourselves. This must be how Custer felt at Little Bighorn.

CMS will not consider any option that does not result in their paying less to providers than before and if anyone here thinks differently then they are just delusional. Look at the last 6 years of history and tell me we aren't going extinct as an industry.