We learn as kids that the best way to resolve disagreements is to work directly with the other party. Whether it’s an argument over who is up next in kickball or who is responsible for which part of a group science project, we are urged to talk it out amongst ourselves without hollering for Mom or Teacher, or later in life, without calling in the boss.
It’s a sound and efficient strategy for many of life’s everyday situations. But its effectiveness hinges on one requirement: Everyone must be committed to working the situation out. If a key player doesn’t want to, we’re left with an “I’m taking my kickball and going home” mess.
So seems the case with complex rehab technology (CRT) stakeholders and the Centers for Medicare & Medicaid Services (CMS). On one side are assistive technology manufacturers, clinicians, consumers and caregivers. On the other are the people who decide whether that assistive technology gets into the lives of the beneficiaries who need it.
Theoretically, there shouldn’t be two sides. Everyone on the list is by definition on the same side, just at different positions along the line: end user of the product, prescribers of the product, fitters and builders of the product, manufacturers of the product, funders of the product.
And ideally, when differences arise — and they will, and that’s okay — everyone should be able to pool their thoughts, ideas and concerns, debate them, and work out a solution.
The discouraging thing about CMS’s capped-rental final rule is that the public comment process has worked before. Remember the power mobility device prior authorization demonstration project going on in seven states? That started out as a prepayment review (phase 1) and prior authorization (phase 2) demonstration, but after receiving and hearing public comments, CMS ditched phase 1 and launched the demo with just the prior authorization portion in place.
The result? By and large, a program that is doing what CMS wanted without crippling beneficiary access to the equipment or driving power chair providers out of business.
So it can be done. We’ve seen it happen. But this time through, CMS asked for public comment seemingly only because it’s forced to do so. It seemed less a call of “We want feedback from those about to be impacted the most” than “We’re legally obliged to request comments, so we will wait the required number of days before releasing our rule the way we’ve already decided it should be.”
In the past when this has happened, a common industry response has been “We need to provide more education.” The theory is that if people really knew what complex rehab technology is, what it can do, how little of the Medicare budget it costs, etc., they would make different decisions. Armed with knowledge, they would use it.
Again, it’s sound theory. But only if everyone is still pulling for a mutually beneficial outcome. Don Clayback, executive director of NCART, says in this issue’s CMS Update column (page 24) that he personally no longer believes CMS’s decisions are the result of not understanding what CRT is. In fact, the reason that CMS is making decisions that make no sense to us — or to Veterans Affairs or consumer organizations or clinicians — may be because CMS has a diff erent agenda than what we’ve assumed it had.
If that’s the case, Don suggests, our reactions need to change accordingly. For my part, I’ve started logging the numbers and nature of the consumer phone calls and e-mails I receive every week from caregivers and beneficiaries desperate to get a wheelchair fixed or a new chair funded. I’m turning over the info to Don so he has it when he takes his meetings to the next level. It may be the only level the industry has left, judging from the way CMS is refusing to play ball.
