Editor's Note

CMS Is Just Not That Into Us (or Our Clients, Either)

• By Laurie Watanabe
• Jun 01, 2013

A few years back, a popular book by Greg Behrendt called He’s Just Not That Into You sought humorously but pointedly to level with single women who make excuses for men.

To the woman who protests that her dream guy meant to call her, but got too busy to dial a phone, Behrendt responds, “The word busy is the relationship weapon of mass destruction. It seems like a good excuse, but in fact, in every silo you uncover, all you’re going to find is a man who didn’t care enough to call. Remember: Men are never too busy to get what they want.”

Behrendt takes no prisoners when it comes to disavowing women of the excuses they dream up. Does your man stand you up? Behrendt replies, “Don’t you want the guy who’ll forget about all the other things in his life before he forgets about you?”

How about He must have lost my number, but I have his, so it’s OK to call him, right? (C’mon, we’ve all been there….)

“If you can find him, then he can find you,” Behrendt says. “If he wants to find you, he will.…A man who wants to make a relationship work will move mountains to keep the woman he loves.”

The author’s generalizations don’t always apply — I recall a Matt Damon movie in which he lost a woman’s phone number because time travelers took it from him and burned it. But I believe the gist of the message: People (of both genders) make time for what is important to them. We make time to confirm our paychecks have direct-deposited at the bank, don’t we?

Thus, I draw this conclusion: The Centers for Medicare & Medicaid Services (CMS) is just not that into us. Nor is CMS into our clients, also known as its beneficiaries.

I don’t base this on just one thing, such as the Medicare competitive bidding program, which awards contracts to DME suppliers at such rock-bottom rates that it’s guaranteeing beneficiaries can only be provided the cheapest products. There’s also Medicare’s defiant clinging to an archaic in-the-home rule. And funding cuts so deep that CMS should know — through research and common sense — that providers cannot supply the best-quality equipment anymore.

Now there is the elimination of the K0009 HCPCS code after flurries of meetings that went nowhere (see the ultralightweight wheelchair update, page 12). CMS has eliminated this miscellaneous code and thrown K0009 products — custom ultralights, standing manual chairs, fully featured bariatric manual chairs — into existing codes without altering the codes in any way.

This defies logic. CMS created the “temporary” K0009 miscellaneous code to hold a few products that didn’t fit into other manual wheelchair codes. Now CMS has decided K0009 chairs do fit into other codes after all? Is CMS saying it was wrong to create the K0009 code in the first place?

Through its actions, CMS is not demonstrating that it believes DME and complex rehab technology providers are an important of the healthcare continuum. Worse, CMS is also implying it doesn’t care much for the outcomes of its own beneficiaries. CMS is supposed to advocate for its beneficiaries. But then shouldn’t it, for instance, understand that it can only cut allowables so far without lowering the quality of the equipment it’s buying? And shouldn’t quality that’s tied to better clinical outcomes be a CMS goal, too?

CMS would possibly argue that it knows it can only cut funding so much, but hasn’t reached the bottom of the barrel yet. I’d retort, “Is your goal truly to provide bottom-of-the-barrel care and technology to your beneficiaries?” I know there are good people at CMS, but the agency as a whole seems to have lost its focus, at least concerning DME and complex rehab technology.

The message of He’s Just Not That Into You is that people’s actions demonstrate what is most important to them. CMS sends a clear message every time it cuts funding, dictates which handful of suppliers its beneficiaries can see, and reduces access to higher-quality technology.

This article originally appeared in the June 2013 issue of Mobility Management.