The Structure of Benzene

Riding on a hot, horse-drawn double decker bus late one night in 1855 London, August Kekule dozed off. When he woke, the famous chemist said, he had “seen” the structure of benzene. Kekule drew out the picture of the benzene ring, and that sketch guaranteed his place in history as founder of the theory of chemical structure.

Since he couldn’t actually see the bonding order of the atoms, Kekule’s vision was based on evidentiary reaction. He saw what happened and he deduced the molecular structure.

I bring this up only because for the first time this year, IBM developed a microscope powerful enough to see the actual structure of molecules (pretty amazing), and it is exactly as Kekule described.

Since December of 2003 when competitive bidding was passed into law, there have been a lot of Kekules in HME. Consultants and others have drawn out their vision of how things would look if the DMEPOS bidding program ever came to pass: thousands of HMEs out of business and a relative few companies doing Medicare business in the bid categories.

Their prediction, too, was based on what they could see, like tightening regulations, the government’s stated intention to cut down the number of providers and its big-hammer efforts to contain fraud and abuse.

Round 1 added more evidence to the dismal picture. In Miami, for instance, only 44 oxygen contracts were awarded when there were 500 oxygen providers in the area. Of course they didn’t all enter the bid, but the numbers showed how devastating the constriction of providers will be if the program is multiplied across the country.

Reimbursements resulting from the 2008 bid averaged a 26 percent reduction, much more for some products. Even bid winners, the few 300-plus of them there were, would have been hard-pressed to continue service at the payment rates that were set. Had the bidding program not been delayed, thousands of HME companies would certainly have shut their doors.

In Kekule’s day, a lot of European scientists pooh-poohed his vision. I guess that’s why his name is in the chemistry books instead of theirs. He took the evidence he had and drew — literally — a logical conclusion.

When it comes to competitive bidding and all the other sock-it-to-me trials and tribulations of the HME business, we’ve seen the evidence of the industry’s changes and we’ve begun to see the consequences.

There may be a lot of things about your business that are not within your control, and if you are dependent on Medicare, that will always be the case. But if you have taken steps toward protecting your vision for your HME against the nightmare of competitive bidding — your service to patients, your place in the community and your profits — then I’m hoping to hear that your company is making history instead of becoming history.

View more competitive bidding stories.