Lessons from a competitive bidding warrior
Editor’s note: The following is an excerpt from Blackburn’s membership address at the PAMS Annual Meeting in May.
The toughest obstacle our industry has encountered over my three-plus decades in this business is CMS’s bid program. In his book, “Good to Great,” Jim Collins wrote that all good organizations have two goals in common: they preserve their core values and they stimulate progress. Competitive bidding impedes both goals!
Our business is based in the Round 1 MSA. This has been a LONG fight! There was never a decision regarding whether we’d bid, but there was also an overriding feeling that while we were attempting to participate, the program had to be fought.
In 2007, when the program was being unveiled, it became very clear that unless our industry and our business voiced its concerns we’d passively be consumed by its detrimental design. That year, my job changed from compliance director to government relations—which gave me a voice for Blackburn’s.
It was the culmination of more than three decades of working with DME, as an ATS, rehab manager and compliance director, that gave me specifics I could discuss. It was time to speak up and speak out!
Blackburn’s has been a member of HIDA, then NAMES, which has become AAHomecare, for years.
We knew our national association would be working on getting the bid program stopped, but how were they to do this without the help of providers? The Pennsylvania Association of Medical Suppliers (PAMS) had really ignited my fire on issues. During my chairmanship of the board in 2006, PA Medical Assistance tried to initiate a new program called selective contracting, jump starting the bid program that Medicare was about to initiate. The board, our members and then new Executive Director John Shirvinsky successfully met with the secretary in regional meetings, we got our beneficiaries to speak out, and eventually we shut that down. To this date, it has not resurfaced. Poor policy could be stopped in its tracks—it was an epiphany.
I’ve had other epiphanies these last six years fighting the bid program, and they are like snapshots in my mind.
Lesson #1: There really is power in voice!
When the methodology behind competitive bidding was unveiled, complex rehab mobility products were included. Rehab had been my life at Blackburn’s for more than 20 years; I knew the complex rehab patient’s needs and the time involved with specifying the right product for functionality.
I could not conceive of drafting bids that included complex rehab patients when each patient was different, required an inordinate amount of time to arrive at the right product, required analysis of the home environment, required a clinical evaluation team approach, and required fine-tuning even after delivery on an ongoing basis.
At an AAHomecare fundraiser in Washington, D.C., for Republican Sen. Arlen Specter in 2007, I was seated beside him. I had just finished my term as board president at PAMS and was recruited to serve on AAHomecare’s executive board of directors.
AAHomecare felt it advantageous to seat me beside the senator so I could speak about the bid program from a Pennsylvania perspective of a business in Round 1. I was hesitant—this was new to me.
Many colleagues voiced their concerns that morning and as he stood and looked down at me, I finally raised my hand and said:
“Senator, our business is within the Round 1 CBA and I don’t know how in God’s name we can devise a bid for a complex rehab patient—each and every patient is different. Rehab products should not be included in the bid program.”
That statement for some reason resonated with the senator and as he joined the large group assembled for his joint address following the breakfast fundraiser, he shouted out, “Where’s Georgie…Is Georgie here?” I was stuffing a donut in my mouth in the corner because I hadn’t been able to eat seated beside him and choked on it as I raised my arm.
He said, “There she is…Georgie just told me why the bid program is not good for rehab patients and I will do all I can to get to the bottom of this.”
And he did!
AAHomecare scheduled a followup meeting in the senator’s office with then Acting Administrator Kerry Weems and I was asked to speak on behalf of providers regarding rehab patients. By the time Weems left, he identified a rehab patient with Christopher Reeves and even shared a story about his best friend who had ALS and was deteriorating.
I won’t say that meeting directly affected the removal of complex rehab from competitive bidding, but I know it helped. Sen. Specter had assured Weems knew about the rehab patient.
Lesson #2: Legislators do listen to constituent concerns and take them to heart!
Dale Carnegie said, “Speak about those things you know if you want to be heard!” I was psyched! If Sen. Specter felt what I said made sense, maybe others would, too!
I contacted each and every representative in our marketing area and one legislative director, Erik Komandant for Democratic Rep. Jason Altmire, called me to better understand my email regarding the problems I saw with competitive bidding. Rep. Altmire was chairman of the House Small Business Subcommittee. He told me that the congressman was going to hold a hearing and asked if I would write a synopsis as testimony. John Shirvinsky also wrote on behalf of PAMS.
He was selected to speak at the hearing and AAH asked if I would speak on behalf of small providers everywhere.
It was an honor and my personal introduction to Rep. Altmire. It also was the first hearing held on competitive bidding and the effect on providers in Round 1. I invited Rep. Altmire for a site visit, even though our business was directly represented at the time by Rep. John Murtha. He accepted. To drive publicity, I invited the local newspaper and the University of Pittsburgh‘s fundraising director, who was interested in our advocacy work, as well as key managers on our staff.
The congressman spent three hours with us, toured our facility, watched how a Group 3 chair was integrated with custom seating and positioning, and reviewed drive controls.
A good give-and-take roundtable followed where we discussed the level of patients we serviced, the illogical inclusion of complex rehab patients in the mix for Medicare’s new program and our opposition to the program as designed. I asked him how he would start to formulate a bid. He said he couldn’t because every rehab patient was different. From that point forward, we had a champion against the bid program.
Rep. Altmire had a healthcare background, having worked for UPMC prior to winning his seat in the House. He believed that health care should not be auctioned to the lowest bidder, that quality of care would suffer. He also understood the importance of accreditation, compliance, community presence.
He was in his first of three terms about to run for his second. He assured me upon leaving our site visit that he would work to stop the program.
Lesson #3: Commit the time, energy and finances necessary to plant a seed—then watch it grow!
In 2008, our industry successfully delayed Round 1. And it was due to champions like Rep. Altmire, who willingly spoke out to gain support against the program.
In fact, he was one of the speakers supporting the delay on the House floor the day of the vote!
I had received a personal call from Komendant, Rep. Altlmire’s legislative director earlier that day. He had told me not to hold my breath—what I was asking for, to delay the program, was a stretch. Later, he called elated, saying he couldn’t believe what had happened and to congratulate our industry! PAMS awarded Rep. Altmire the “Legislator of the Year Award.”
Our industry was promised improvements with that delay. But, Round 1 was rolled out by President Obama shortly after he took office his first term. We had hoped many important changes would be made, but it remained much the same. We were so disappointed.
Another hearing on the bid program was held in 2009, and I again testified on behalf of AAHomecare and small providers in rural areas. I was surprised when Rep. Altmire came in to personally introduce me. He spoke about his site visit and the services our firm provides 24 hours a day, our commitment to our patients. He shared how we’ve been a part of our community for almost 75 years.
He really did know us! I realized that a relationship was forming.
He had helped our industry in the past, and I wanted to make sure this savvy champion stayed in Congress and hosted a fundraiser, first in Tarentum, then twice in Pittsburgh over the years. AAHomecare, Pride Mobility Products, Invacare and many other industry leaders co-hosted the events and traveled in to be there in person. Many of my PAMS colleagues were on hand to support him and he was elated at the turnout.
It reinforced his commitment to our industry and to our cause.
The House changed to a Republican majority and another friend and loyal supporter, Rep. G.T. Thompson, emerged. Rep. Thompson had a clinical healthcare background and also responded very positively to my concerns about the program in our initial meeting during his first term. He and his legislative director, Matt Brennen, were go-getters—they wanted the bid program stopped.
Jay Witter, Seth Johnson, Cara Bachenheimer and our own John Shirvinsky became my mentors. I continued to ask legislators for help, but my mentors taught me how to put that in the context of what could be done. In a bi-partisan move, Rep. Thompson and Rep. Altmire introduced a bill to stop competitive bidding. We got a significant number of names on the bill, but at the end of the congressional year, we all knew it wouldn’t go anywhere unless we had a substitute plan and that didn’t surface until last year with the development of the market-pricing program (MPP).
Importantly, Reps. Thompson and Altmire’s bill served as a placeholder for MPP, keeping the negative and illogical aspects of competitive bidding alive until a replacement program would be adopted. Rep. Thompson was given the PAMS 2011 “Legislator of the Year Award!”
Lesson #4: In politics, redistricting can hugely affect relationships
In the last election, Rep. Altmire lost his seat. He was a centrist voter, had never missed a vote in all the years he was in office, and voted against the Affordable Care Act—he voted according to what his constituents wanted. I believe it came back to haunt him within his own party. A victim of redistricting, he and Rep. Mark Critz battled in the primary. Rep. Altmire lost. Poor turnout in his region was blamed. The unions also had backed the Affordable Care Act and he didn’t. He thought it was too costly and inefficient. Regardless of the reason, we lost one of the best champions we have ever had.
Then Rep. Critz lost to Rep. Keith Rothfus—a Republican. I have begun the educational process—again. We’re currently in the midst of scheduling a site visit, but we already have his support as a co-sponsor on H.R. 1717.
Lesson #5: Backing good people in Congress is a good business decision. Building new relationships—a necessity!
The challenge to develop relationships and educate on issues is ongoing. People may change, but our issues remain. Fundraising is a key way to do build relationships. Mal Mixon, chairman of the board of Invacare, told me last year that he was having a fundraiser at his home for House Speaker John Boehner and I said I’d love to meet the speaker. Mal’s response was, “Do you have $50,000?” His fundraisers and mine are very different! But both serve a purpose!
Chuck and I, and Ron and Jo Jean have supported and hosted many fundraisers for legislators in our service area and for industry champions since 2007. It enhances the bridge building.
Since 2007, our legislators have challenged us to come up with a replacement methodology for competitive bidding. I wanted and our industry wanted competitive bidding to just go away—it was hard to swallow the fact that a pay-for was required. Our champions knew they couldn’t stop the program without an eventual replacement.
Do you recall how the industry became incensed at the 9.5% cut to achieve the delay in 2008? Now we are facing 45% cuts in DME in Round 2 and we’ve been living with an average 36% average DME cut in Round 1 in Pittsburgh since 2011! Our situation is serious.
LESSON #6 – The answer eventually surfaces. Stay positive!
In April, H.R. 1717, “The Market Pricing Program Act of 2013,” was introduced by Republican Rep. Tom Price of Georgia, a physician, and Rep. John Larson of Connecticut. They are colleagues of our own Rep. Mike Kelly, the PAMS 2013 Homecare Champion. All sit on the powerful House Ways and Means Committee. MPP levels the playing field; it allows us to stay in the game!
With Round 1 already out of the gate since 2011; with CMS propaganda stating there aren’t any significant issues or complaints; and with Round 2 ready to begin July 1, battle lines are drawn.
Here’s the challenge: We must garner legislative support for MPP! We must do that with data. We must do it quickly! The lack of transparency in this program must be challenged; the outrageous low-balled discounting must be dissected. CMS must be made accountable for ignoring the recommendations of 244 auction experts as we struggle to keep our firms thriving and continue to service patients.
We need hearings to question CMS’s assertions about the success of the program. We need to challenge CMS’s award procedure—who got in, who didn’t and why? What are the financial qualifications—they’ve never been shared! Why were awards given to non-licensed companies in various states? How were capacity estimations determined? What is the formula for establishing financial credibility of award winners?
As of July 1, 91 more CBAs will be involved. Chances are Round 2 will involve your business like it has involved Blackburn’s the past three years in Round 1.
I know how hard our national association and key manufacturers and their lobbyists have worked to get the bid program stopped. I know how hard state associations have worked and are working under the tutelage of John Shirvinsky to amass data to share with legislators.
This is NOT the time to claim fatigue! This is NOT the time to feel dejected! This is NOT the time to criticize! This is NOT the time to let someone else do your talking! This is NOT the time to back down and succumb to CMS propaganda about 45% savings and a promise of improved quality care! This is the time to come together and speak with one voice.
I know perseverance wins. Let me share a very personal story.
Early in 2010, I got a call from Rep. Altmire’s chief of staff, Sharon Werner, inviting me to attend the First Ladies Luncheon with Mrs. Altmire. She explained this was an annual event for congressional spouses; the congressman’s wife took one constituent a year. The staff had a vote, and I was the constituent! I was so honored!
The night before, there was a reception in the Library of Congress. Rep. Altmire personally took me through the books of Thomas Jefferson, which reside there. We viewed letters of first ladies ranging from Mrs. Adams to Mrs. Bush—history could be traced in their handwriting.
The next day was magical, seeing and hearing the first lady speak, witnessing in person the Navy band, the gorgeous luncheon, the tenor from Le Miserable crooning “Bring Him Home.”
During the drive home, I received a tearful call from my son that his wife, our 29-year-old daughter in law, Alison, had a biopsy done that day. The doctor quickly called them back into his office to explain they were facing Stage IV breast cancer, with metastasis to the lymphatic system. The doctor was very, very sorry. Their boys were 2 years and 9 months old. A troublesome lump thought to be a gland for three lingering months finally had been biopsied at their insistence and the news was bad—the very worst. Alison’s prognosis was not good.
That day is engrained in my memory—from surreal highs to incomparable lows.
My point is this: That evening, April 28, 2010, Alison told me she would survive despite the odds. The numbers given by her doctor meant nothing to her!
Two years later, Alison was honored as the cancer Survivor of the Year for West Virginia University Health System, speaking to 350 clinicians from around the country on the power of a positive outlook and carefully individualized patient care! Today, her six-month PET scans still remain clear, the next is this month. The boys are now 5 and 3, and thriving! They have a family life!
To us, it’s a miracle, but not to her. She believed she could beat cancer and did whatever it took from three bouts of chemo to multiple surgeries to radiation to more surgery to make that reality!
She never gave up. She never gave in! Her confidence was contagious!
LESSON #7: I learned from Alison to achieve any goal, we must believe we can!
I believe success is found at the intersection of challenge and opportunity! Friends, we are at that intersection! Some say our odds are not good at getting MPP passed! I say there are no odds—only data! We will never know what we can accomplish unless we try! Now is the time to contact our legislators, be relentless, be tenacious, and be passionate. The illogical data from Round 2 is powerful proof.
Let’s WIN with facts. Let’s educate together! Let’s beat CMS at their propaganda game.
AAHomecare’s Washington Legislative Conference is May 22-23 in Washington, D.C. Be there. It’s our time to shine!
Georgie Blackburn is vice president of government relations and legislative affairs for Blackburn’s in Tarentum, Pa.