Commentary: Draining the CMS Swamp Won’t Happen Overnight

Posted on in HME Government Issues, Thought of the Day

By John Gallagher, Vice President - VGM Government Relations

What are the most important things needed to break a nut loose from a rusty bolt? Some WD-40, a few good tools, and an abundance of elbow grease. Much like that rusty bolt, Health and Human Services Secretary Tom Price is working to break the bureaucratic rust loose within the agencies he oversees.

There are plenty of concerned providers who are worried that Price, a strong advocate for the HME industry during his time in Congress, has forgotten about problems that must be solved. While the urgency of real reforms increases every day and providers continue to struggle to keep the lights on, the industry must recognize the machine that Price is working against and the steps his department has taken to make incremental improvements already.

Price has Already had an Immediate Impact on DME

Round 1, 2019 of competitive bidding was pulled shortly after its introduction because of Price’s actions prior to being confirmed as secretary. Something equally as important, the industry is seeing a much different CMS since Price took over the reins. We are seeing the leadership at CMS beginning to be much more willing to respond to inquiries, including new Administrator Seema Verma, something that we have never seen from CMS or HHS.

Reduced Staff Numbers Slow Down Change

Price, as well as many other agency heads, is working with greatly reduced staff numbers. This is largely due to politics in Congress playing out with confirmations and budgets, but it is having an impact. This translates to battling with career CMS employees working to protect their positions and who are married to flawed programs that are harming providers and patients. An encouraging response that we have heard from more than one official within CMS is that senior staff that came with Price are quickly gaining the respect of the rank and file employees.

Where is the Magic Wand?

Many are wondering why Price cannot just snap his fingers and solve the problems facing the industry. Unfortunately, there is no magic wand to wave over everything to be solved. While he has overall authority of the direction that these agencies take, there are still rules and statutes in our government that prevent him from having complete, unilateral power. There are lawyers and career staff who follow lockstep with the bureaucrats and leadership already in place at CMS, which aren’t the most friendly when it comes to interpreting the intent of congressional action.

Agencies Need a Mandate for Quick Action

In order for a department or agency to act swiftly, it needs to be pressured or shown the demand for change by Congress. We are seeing an increase in congressional inquiries coming from key committees and leadership, which raise red flags with the status quo within CMS. This continued concern from Congress is a direct result of the constant outreach from grassroots providers calling into offices, attending meetings, and messaging members of Congress through the VGM Action Center. Providers need to continue demanding change by CMS in order to keep that pressure on.

Even though HME plays an extremely important role in the world of health care, we have to recognize that the secretary has countless “irons in the fire,” most notably the repeal and replace of the Affordable Care Act. The unknowns and delays in passing legislation to replace Obamacare has clogged the pipes of legislative and regulatory action. I have no doubts that Secretary Price has not forgotten the problems going on within the DMEPOS industry. The costs, readmissions, and health care problems that are prevented by this industry do not go unnoticed. This is especially true with the secretary as he is working to overhaul the health care system in order to put patients at its center.

The frustrations that providers feel are not doubted and are absolutely understood. Providers have to channel that frustration to the people who will listen most, their members of Congress. It has been just over four months since Price took over as secretary, and he has worked with limited staff and resources at his disposal. It takes time and energy to break a nut loose from a rusty bolt, and Price is doing just that. While the industry would love to sheer that rusty bolt off, he has doesn’t have that luxury because the agency has to still function, and we don’t want CMS to actively work against him, which would only make things worse.

Grassroots HME providers are some of the most hardworking and driven individuals in health care because of the high level of care they provide their patients. The industry has to allow Secretary Price the time to create relationships and drive CMS down the correct road and trust that he is doing so. The industry has made concrete changes to show that clearer skies are ahead, and that the nut is breaking loose from a very rusty bolt.