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Will Paul Revere Show Up In Time?

Years ago I started my professional career as a history teacher. This passion for history certainly has a significant impact on how I view things. I’m experiencing one of those moments right now regarding competitive bidding… and my mind is being drawn to Paul Revere and the beginning of the Revolutionary War.

In early 1775 everyone knew that hostilities was not an “if” statement, it was a “when” statement. In order to be prepared and to respond quickly and effectively a large network was created to keep watch on the movements of the British military. We all know how the story goes from there… on April 18th, 1775 Paul Revere, and the lesser know William Dawes, were informed that attack was eminent and the ride announcing that “the British are coming” became a famous part of American history and folklore.

I see a lot of similarities between December of 2010 and April of 1775. We all know that competitive bidding is eminent, we even know when it’s going to start, and we all believe that it’s going to produce casualties. What we don’t know is when and where the first casualties will occur and how we’ll spread the news to rally our forces.

What would have happened if Revere and Dawes hadn’t sounded the alarm? Well, in my opinion, it’s quite possible that John Hancock and John Adams would have been captured by the British. Hancock went on to become the President of the Continental Congress and Adams was a powerful, influential member. Both were among the most ardent supporter of us declaring independence from England and Adams was a member of the committee that drafted the Declaration of Independence. If these two figures had been captured they would have never assumed those positions within the Continental Congress. Would we have declared independence without them? If we had, would it have come too late? Could the British have already entrenched their military and squelched resistance? Bottom line, I’d argue that without Paul Revere and William Dawes and their historic ride our history and our country may be quite different today.

OK, so I’ve given everyone a history lesson, what does this have to do with Medicare competitive bidding? Well, the way that I tie these events together is that we are once again faced with an urgent need to keep close watch on what is going on and we must be ready, willing and able to sound the alarm on a moment’s notice.

Many of us have argued loud and long that competitive bidding is going to have a significant, detrimental impact on beneficiary access to quality goods and services. Yet, as sure as we are that this will happen… we don’t have any proof. Our proof will only materialize after competitive bidding goes into effect in the first nine metropolitan areas in January of 2011. Yet, what happens if we aren’t ready, willing and able to find the proof and sound the alarm as quickly as we possibly can? This is my greatest fear! I am very concerned that beneficiaries will be slow to recognize the decline in quality and access produced by competitive bidding. Existing beneficiaries may not need replacement or additional equipment for some time; or, they might be covered under the grandfathering provisions. Either way they won’t notice any changes for some time. New beneficiaries that have never obtained DME via Medicare before have no basis for comparison regarding how their access to, and quality of, good and services has been changed by competitive bidding.

Once 2011 starts the clock also starts ticking on the implementation of round 2 of competitive bidding, and this time it will be in 91 metropolitan areas! I really believe that the product categories and codes will be announced in the first half of 2011 and the actual bidding period will close before the end of 2011. Will we get the proof in time to have any effect on any of these events? Will the alarm be sounded from round 1 soon enough to do anything to defend us from round 2?

I believe that our only chance of getting enough evidence in time to make any compelling arguments to influence round 2 will require a concerted effort by all of the provider and manufacturer stakeholders of the DME industry. To get this evidence we will need to do all of the following:

  • We’re going to have to educate referral sources on what to watch for and solicit their support to keep us informed on any issues they encounter or concerns they have. This will be the group most capable of identifying problems in the early days of round 1.
  • We need to develop a beneficiary “Bill of Rights” defining what they should expect as far as goods, services, response times, etc. We need to educate them on what competitive bidding is “supposed to do”. According to CMS a primary goal of competitive bidding is to reduce beneficiary out of pocket costs while maintaining, if not enhancing, access to quality goods and services. We need to solicit these beneficiaries to keep us informed as well.
  • Finally, we need to educate beneficiary advocacy groups and gain their commitment to keep us informed as well.
  • We need to pull together as an industry to face this challenge together, rather than only focusing on the needs of one product or geographic sector.

If we do this we will have created a network like our forefathers had back in 1775. All that will be left is for us, the provider and manufacturer stakeholders, to take on the roles of Revere and Dawes and sound the alarm. The American Association for Homecare has already set up methods on their website to report problems: and I’m sure that other trade groups will as well. It’s up to us to make sure and get the news to them.

I already told you what I believe could have happened if Revere and Dawes ride had not occurred. I don’t want to imagine what will happen if we fail to sound the alarm on competitive bidding issues.

I’m not sure whether our cry will ever be remembered like “the British are coming” but it is certainly no less important to our industry, our companies, our employees, our clinical partners, and, most importantly, the individuals that depend upon us for the goods and services they need.


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