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Against all odds, I found myself temporarily sucked in today by the video of last week's hearing on Medicare and DMEPOS, led by Sen. Claire McCaskill. Now I see what one industry insider, who attended the hearing meant, when I inquired how it went: "Sen. McCaskill is totally uninformed."

Now, to be fair, I didn't watch most of the hearing, just a snippet. While I understand (and support) McCaskill's concerns around shady marketing tactics, the snippet I saw showed a lawmaker getting caught in the weeds in my opinion. In referring to a company called Med-Care, she honed in the fact that, on the phone, it might sound like "Medicare." OK. I guess I can see that, now that she's pointed it out. Did the company do that to be deliberately confusing? I don't know, but neither does she.

She certainly talked about it a lot, though, going so far as to press CMS' Peter Budetti on why they would let a company name themselves as such. I gotta give Budetti credit for answering with a straight face when he told her he didn't think CMS has the authority to dictate what folks call themselves.

McCaskill then went on to question why physicians aren't supplying HME (this whole discussion cued off a beneficiary's letter about CPAP supplies)? I think she thought that would be better than the guy in the middle who stands to make all the money. (That would be YOU, the HME provider she was referring to).

I mean, is she suggesting scrapping the whole HME system? And what about drugstores? And labs? Should doctors do all of this?

I am still scratching my head.

Theresa Flaherty

I am obsessed with a Slate advice column called "Dear Prudence." In fact, after I first stumbled upon it, I engaged in a few marathon sessions reading through the archives (not at the office, Liz). Sample headlines: I've been banned from my vegan grandbaby, how will she get her meat and cheese; Since starting on antidepressants, my wife has been cheerful and optimistic. I hate it; and this recent fave: Help! A neighbor has been poisoning our cat colony.

So imagine my joy at finding an opportunity to incorporate Prudie into an HME News blog. It's from about a year ago, I believe.

Q. New Job: Back in May of 2011, I decided to get back into truck driving. A large faith-based company agreed to hire me. I went through orientation, and was in the process of putting my belongings in a truck when I was called up to the safety department. The director of safety had found out that I have mild sleep apnea (my roommate snitched on me). He wanted me to travel back home, undergo another sleep study, and get a letter from my doctor stating that I could drive without any restrictions. Here's the problem: The safety department never had me sign any release for them to discuss this matter with me, or anyone else, let alone even look into it. I asked a lawyer friend about this, and he told me that it's a violation of my HIPAA rights. I am currently driving for this company, but I am tempted to quit, and file a lawsuit against them. To sue, or not to sue?

A: I often get chastised that I don't suggest more often that people just sue. But your letter beautifully encapsulates the litigious world we live in. You're considering suing over the fact that the trucking company that employs you discovered you have a medical condition that could result in your falling asleep at the wheel. I'm wondering whether in the papers you signed for your job there wasn't a line about disclosing relevant medical information that you neglected to note. In any case, your roommate snitched presumably not out of malice, but out of concern for the other people on the road. Instead of entering the legal system, enter the medical system and find out if pursuing this line of work could mean you're a danger to yourself or others.

Now, it's not the most interesting letter, but it does show how far there is to go in many cases, with understanding sleep apnea. In the May issues (coming soon to a mailbox near you) I have a feature on some soon to arrive guidelines from the Federal Motor Carrier Safety Administration geared to just this population.

Another thing about Dear Prudence, is because it's an online forum others will weigh in with their two cents. In this case, 2 cents that isn't worth the copper it's stamped on:

Q. RE: Sleep Apnea: Prudie, I believe that you are a bit confused as to what sleep apnea is. It is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur five to 30 times or more an hour. So, it would have no bearing on his ability to drive a truck, it is not like he has narcolepsy and is just going to fall asleep at the wheel!

Now this person obviously knows what sleep apnea is, but note the last sentence! Really?

By coincidence, Dana Voien, of SleepSafe Drivers, sent me a study link over the weekend. Sleep apnea patients are--wait for it--more likely to fail driving tests. So, there's obviously still room for growth in this market.

Meanwhile, if you want to check out Dear Prudence: "Help! My girlfriend kisses her cat and it grosses me out!" 

The more I think about the mail-order program for diabetes, the more it ticks me off. I mean, every week folks (not just in the diabetes space) come up with all sorts of creative ways to criticize the program or question various technical aspects. And, while I have covered this in depth, the more I think, the more questions I have.

For example, by its own estimates, CMS has said that about 6 million beneficiaries are expected to be impacted by the mail order program (that's in line with the percentage of beneficiaries who use mail order anyway). But isn't that estimate based on bennies having ample local choice if they so, uh, choose? If you consider that CMS changed gears mid-stream (like, after the bids were submitted) and decided to apply mail order pricing to everyone, than wouldn't that mean CMS should, to use one of its favorite words, extrapolate those numbers? After all, even before the Round 1 rates (56%) came in, before the Round 2 rates (72%) came in, CMS has said that bennies would have that choice, indeed that safety valve of your friendly local diabetes dealer?

With such a drastic cut, it's a good guess that a lot of those safety valves are going to plug the drain that is Medicare diabetes. Leaving, oh, let's take a guess, a few million more beneficiaries to switch to mail order providers who were awarded contracts based on smaller capacities.

Also, and this could apply to all categories, but, if providers submitted bona fide bids, based on what they could afford to offer a product for (and submittted the invoices to back it up), and then accept contracts at far below what they bid, how is that supposed to work? I mean, call me naive, but if wouldn't they have bid lower if they thought they could afford that? Is CMS requiring contractees to prove they can still honor contracts at those much lower rates?

Theresa Flaherty

As I edit the pages of the forthcoming April edition of HME News, I come across interesting tidbits. Take, for example, the Richard Barnes commentary on employee engagement.

Did you know that, according to a Gallup Poll, only 29% of employees are fully engaged in their work? And that 54% have mentally checked out (Hey you with the computer solitaire, we see you). Our fave stat here at HME News world HQ (which we share with a few other folks on a sister publication) was this one: 17% of employees are actively disengaged AND sabotaging the efforts of coworkers. With about 22 folks here in the office we estimate that four of us at any given time are saboteurs (smart money's on the new-ish guy).

As Round 2 continues to wreak havoc throughout the industry, I would imagine some of these numbers will rise among HME employees. After all, it's tough to work in an environment where folks are losing jobs, pay is being reduced and uncertainy is the only certainty.

For those employees left standing, here's a few signs that they are actively engaged: they are 26% more productive, twice as likely to be top performers, and miss 20% fewer days of work. Simply put, if you "bring it" to work and don't play hooky on a regular basis, your coworkers probably won't be giving you the fishy eyeball wondering if you are out to get them.

The commentary also says that constant complaining about the company is a bad sign, but I don't know. Isn't that just cubicle nature?