'We've given more than we can take'

Friday, March 22, 2013

The overwhelming question that came to everyone’s mind after the latest single payment amounts (SPAs) were released for Round 2 of competitive bidding was: “What do we do now?” Pundits and providers alike were shocked that the SPAs came in so low. Most of us across the country believe that these bid amounts simply can’t be accurate and are arguably unsustainable. Surely, this isn’t real.

Well, guess what? The SPAs are real, regardless of whether or not they are accurate. After conferring with industry experts and providers throughout the U.S., the prevailing sentiment is that we have to work harder to convince Congress that this program is fatally flawed and will unceremoniously crash under the weight of suicide bids by desperate providers. But I propose that may not be the case.  

For too long we have prognosticated to members of Congress that, if allowed to continue, the competitive bid program would wreak havoc on the home healthcare system. And what have been the results? A delay that cost the industry a reimbursement cut of 9.5%, a re-bid of Round 1 with worse SPAs than the original Round 1, the creation of the MPP program that nobody really wants, and now a devastating Round 2. Well, perhaps it is time to let Armageddon occur. If we so vehemently believe what we are saying about an impending crash, then why don’t we stop asking to replace it and start saying to Congress: “We’ve done all we can to stop this, the blood is now on your hands.”  

This approach offers more hope than any other course of action. First, contracted suppliers will get what they ask for: contracts. Now they can figure out what to do with them. Certainly, the rates aren’t sustainable, and service and product availability will have to be forsaken. This is bad for Medicare beneficiaries. They won’t get their equipment in a timely manner, if at all, and will be forced to pay cash for it from providers who don’t have contracts. This is good for all the remaining non-contracted providers, as they will be in high demand.  

And what is bad for Medicare beneficiaries will not be welcomed by members of Congress. As news starts percolating of long delays and beneficiaries paying cash instead of receiving the great savings they were promised, Congress will have to realize it made a tremendous mistake. They will invite us back to the table to discuss a solution that we may not want to listen to. The idea that somehow our industry must “pay for” a solution suggests that we are somehow at fault for the current problem. Well, we are not. You don’t see the American Medical Association offering up “pay fors” to push off the “doc fix” every year, do you? They simply state the facts and say, “It’s on you, Congress.” Congress acknowledges this and every year they push off the “doc fix” until the next year.  

If I were to offer our industry a bold plan of action going forward, it would be this: Stop pushing MPP and start saying, “We can no longer be held responsible. We tried and nobody listened. Now face the music.”

Come July 1st, with the help of state associations, I would run full-page ads in every competitive bid area every week asking Medicare beneficiaries to call their congressional representatives if they are unhappy with the equipment and service Medicare is providing them. List the representatives and senators in the ads and their phone numbers.  

Forget about going forward with MPP and start talking about full repeal of competitive bidding. Offer instead to work with CMS to find new payment allowables and payment modalities that benefit all of us—Medicare, beneficiaries and providers. Many state associations have been very successful in this approach with Medicaid. It can also work for Medicare.

We shouldn’t look at Round 2 as the end of the world. Conversely, we should look at it as a new beginning. A beginning that clears us of this train wreck and places us back in control of our collective businesses. We offer a lot more than we take from society, and now society will find out how valuable this truly is.