When the CMS Open Door Forum series started under then-Administrator Tom Scully back in the early aughts, it was seen as a peace offering amid some otherwise rough times. Although Scully wasn’t around long to see the program mature, here was a laudable effort to meet and hear the citizens over whom the Centers for Medicare & Medicaid Services czar ruled.
I don’t recall that Scully ever attended one of these early confabs, nor do I know that they were even his idea. But no one could deny they were a nice gesture.
They still are, in fact, and are often more than just a mere gesture. But they are also often flawed productions in a well-intended program.
If we’re being totally honest in the wake of the Thursday’s SNF/LTC Open Door Forum, the program needs a new compass. Or at least a firmer hand at the tiller, to keep up with the nautical theme.
The pregnant pauses after requests for information were unnecessary and embarrassing. Not only because they happened but because they occurred both after questions posed by provider-listeners and when statements were made among officials running the call themselves.
Make no mistake: There are very hard-working people at CMS, and those left to face the provider hordes each month are indeed intent on trying to help. Of that I’m sure.
But can somebody give them a little more support, please? The agency sets these calls’ agendas, so it seems only fitting that it should be ready for what ensues. If that means having on hand friends from related bodies such as the Centers for Disease Control and Prevention, or somebody who can speak on their behalf, so be it.
One got the sense that part of the problem Thursday was higher-ups who had hung their representatives out to dry. There’s only so much you can improvise on a national stage when a program isn’t fully completed yet or information isn’t freely shared among speakers before the show starts. Sometimes, pre-announced speakers or responsible parties don’t attend these forums, also leaving their colleagues holding the bag. We’ve all been there in our own work lives. It’s not fun.
A prime example of a program problem was an easily anticipated question Thursday on the arrival of certain MDS materials. It should have been a snap to answer quickly, even if the response wouldn’t be warmly received. Instead, there was awkward buck-passing and then instructions to study guidance for other sectors for the type of thing that skilled providers can expect … at some unknown time in the future.
That brings up one built-in hazard of these call leaders’ jobs. Federal bureaucracy admittedly demands immense amounts of flexibility. That includes from its dependents, such as Medicare and Medicaid providers. But as more than one forum call attendee noticed Thursday, dodging questions or complimenting the listener without really answering a question goes only so far.
The truly unfortunate part of this is, the dodging or simple lack of awareness drains confidence from the agency and the system itself. Skilled care providers exited Thursday’s call wondering if those in charge truly understood what operators are up against with the sweeping changes under the new MDS.
Maybe it’s a classic case of the infantry grumbling about the brass not appreciating the work that needs to be done. But several times, there was a sense that call leaders did not have a full grasp of the breadth and potential residual effects listeners will have to deal with, and deal with in a relatively short amount of time.
“Do the various CMS departments talk to each other?” is the post-event comment that really sticks with me.
Yet we know they do — or at least will do so — talk to each other, that is. That’s because they told us so. Numerous times listeners were promised that colleagues would be informed about concerns that had to be tap-danced around or sidestepped.
(“Thank you for your input” was the memorable non-response to one question. “I definitely agree” was the start of another reply to a query that asked for advice on how to handle a problem, not agreement on anything.)
The point is things don’t have to be this way. Some of this could be solved with a firm, keep-it-moving CJ Cregg-like hand.
What it all really comes down to is if CMS leaders are going to throw these monthly soirees — and by all means, they should — they owe it themselves to be better prepared to entertain (questions from) their guests and be ready to keep the beat going, whether they’re delivering welcome music to attendees’ ears or not.
James M. Berklan is McKnight’s Executive Editor.
Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.
