With CMS, right makes might

Does Medicare actually listen to provider protest? Given the uproar over the planned cuts to power mobility and CMS's rejiggering of the fee schedule, it would seem so. The industry, not surprisingly, mounted a very vocal, very aggressive campaign that decried the cuts. The mainstream media picked up the baton on this one like we've never seen before. Usually, threats by providers to close their doors go in one ear and out the other of Medicare officials. I remember talking to a DMERC official who confirmed as much, saying that provider protests were always heard and always listened to with a healthy dose of skepticism. "We expect alarms and excursions from them," was the gist of the official's remark. This time, however, it was different. The cuts to high-end rehab technology were mind-bogglingly deep. You have to wonder what's going on here. Were CMS officials really blind to the costs of their service contractors? Were they that ignorant? Or were they trying to punish the senior mobility dealers whose volumes and disreputable practices have blackened the collective eye of the industry? Perhaps the latter, but that still doesn't explain why they were going to make it impossible for some of the industry's most reputable suppliers like Tim Pederson to do business. CMS has cut the oxygen benefit repeatedly through the years, and they've yielded what they've wanted. There was the big kahuna in BBA 1997; there was the gradual erosion of profit that comes from escalating costs and no CPI boosts in subsequent years. And yet, for all that, there are more suppliers than ever before; the technology's gotten better; there's been no outcry. So we can't blame CMS for believing that this industry, like any industry, would cry wolf at any compromise of reimbursement since such a compromise, in oxygen, did not compromise the benefit. What may have spelled the critical difference in this rehab situation was third-party intervention by institutions like Craig Hospital in Englewood, Colo., by consumer groups like the Christopher Reeves Foundation and by coverage in the mainstream media. The HME industry has always known that it has had to muster a critical mass of ancillary support to increase the odds for success. It's not enough to simply summon support from a legislator. While, ultimately, only a critical mass of legislators can turn the tide against a law, it's a given that some member of Congress, somewhere, will support anything they're paid to support. But it's these honest brokers, like Craig Hospital and the mainstream media, that'll turn the real tide. You can't win their patronage through lobbying. You can only earn it when you're right. And with regard to the cuts to high-end rehab, the industry was obviously right.