Letter From the Editor

Living in a Reality World

• By Elisha Bury
• Jul 01, 2008

Everyone has a vice. For me, it’s an unhealthy addiction to reality TV. Sure, I understand that these shows require very little creativity and rely mostly on people who enjoy making fools of themselves. Still, I’m inexplicably drawn to the debauchery that headlines primetime TV.

One of my favorite shows was just debuting at press time. “So You Think You Can Dance?” — modeled after the ever-popular “American Idol” — starts off by touring cities across the nation to find the best dancers to compete for a chance at becoming America’s favorite dancer.

The judges do not pull punches. They know specifically what they’re looking for: someone who is talented; who is well-trained with obvious signs that he or she has invested time and energy into learning proper technique; who shows potential for greatness; and who has a presence that Americacan trust. It is only these select few that will be permitted to compete, and the rest are thrown off stage with very little compassion.

Watching this show got me thinking about the meaning of competition, and it was easy to compare it to what’s going on in our industry. Recently, the HME Media Group sat down and analyzed the winners of the first round of competitive bidding across MSAs and product categories. (Check out the analysis.) What we found was remarkable: A handful of select providers winning across MSAs in multiple categories. For example, winners from California, Florida and Texas will be delivering service-intensive products such as oxygen, CPAPs and rehab to areas far outside their service areas. These companies do not currently have branches in these locations, as far away as Ohio and Pennsylvania. Some won bids in categories outside their expertise, leading many to question if these providers understand the costs of providing those products. How can you possibly bid on products you do not offer?

Certainly, the Centers for Medicare & Medicaid Services (CMS) failed to outline the criteria for this competition. According to our analysis, the new fee schedule shows significant cuts in reimbursement when compared to the former fee schedules. From the looks of it, CMS chose simply based on the lowest price, a poor indication of quality and also a poor indication of the true costs of providing products.

At best, the bid contracts from round one represent a free-for-all — though some excellent providers did win bids. Still, there certainly is no spirit of competition. Our judges are not trying to offer what America wants: the best possible service by the best possible providers.

Perhaps it’s time for CMS to take a cue from reality. And it’s long past time for our industry to reach for the phone to Washington.

This article originally appeared in the Respiratory Management July/August 2008 issue of HME Business.