In my spare time, I’m a sucker for black and white slapstick comedy. If challenged, I could probably recite every line and verbally recreate every scene from the Marx Brothers’ 1933 comedy classic Duck Soup, complete with Harpo’s pantomimes and horn honks. I also do a mean imitation of Curly Howard of the Three Stooges running on his side if prodded, just not right now.
What makes slapstick comedy gratifying is the belief that it exists strictly in the realm of entertainment. In real life, we tend not to see pie fights at society parties, wars won because the leader of the enemy country is being pelted into submission with fruit or adults getting hit square in the face while playing dodgeball. We tend to think that institutions can’t descend into complete and utter chaos due to one bad decision, yet the process looks really easy to accomplish with the right script, the right actors and a skill for setting up a humorous situation.
In the absence of an abundance of banana peals and squirt bottles full of seltzer water, the closest parallel we have to slapstick comedy in our daily lives is the decision-making process of our federal government, particularly in relation to its unctuous administrative giveaways to large American businesses. As an illustrative example, I present Palmetto GBA, which in the past two years has quickly risen to the top of the list as a California physician’s least favorite wholly owned subsidiary of Blue Cross & Blue Shield of South Carolina.
During the last presidential administration, someone in government decided that it would be a wonderful idea to take the assignment of Medicare contractors for some states and shift them to other contractors. As part of that decision, Palmetto GBA, who until 2008 had been responsible for some of the smaller states in this country, was given oversight of the state of California, which by itself is the 7th largest economy in the world. Simultaneously, the decision was made to move every provider to a National Provider Identifier (NPI).
What was planned was a smooth transition from one carrier to another with an accompanying, long-awaited transition to a single provider ID number. What resulted in mid-2008 was comparable to Lucy and Ethel at the candy factory, with too little staff assigned to too big a task. This would be the perfect situation for high comedy were it not for the fact that it sent tens of thousands of medical practices in America’s largest state to the brink of bankruptcy due to long-delayed NPI enrollment applications and lack of staff to answer basic questions leading to resolution.
In the fall of 2008, a flurry of press releases emanated from Palmetto GBA in typical corporate style stating that the problems were being addressed, additional staff was being added post-transition and that everything was going to suddenly metamorphose into a fantasy land of fairies, elves, candy buttons, marshmallow clouds and rivers of pure chocolate. In the roughly 18 months since, it can be successfully argued that the same problems still exist, only instead of NPI, Palmetto GBA has now demonstrated their lack of readiness a second time with their approach to the PECOS/referring physician database issue.
As an illustrative example, one of our California providers, was having a problem with his Provider Transaction Account Number (PTAN). When our credentialing specialist contacted Palmetto GBA, the person answering the phone stated that the physician did not have an individual PTAN. It was shortly after this that the physician received a letter stating that the same supposedly non-existing individual PTAN was being deactivated. Further investigation revealed that this stemmed from a suite number in the correspondence address being entered incorrectly in Palmetto’s system, which in turn caused a conflict with the PECOS system, hence the threatened deactivation.
Mercifully, CMS has now delayed Phase II of the PECOS project until January 3, 2011, which gives Palmetto GBA roughly 10 months to discover another integral process for which they lack either competent staff or updated information. The lesson of California’s painful transition is still playing out, as the last 14 states in the five jurisdictions yet to go through administrative carrier transition are being delayed due to protests being lodged with CMS. This affects the four additional states that will be under Palmetto GBA after final transition. Spare a little pity for the provider communities in the Carolinas, Virginia and West Virginia after all is said and done.
All of this provides an abject lesson in governmental process. It is hoped in the future that legislative changes with profound financial side effects will more resemble a workable, functional business model rather than a 3-dimensional tribute to Larry, Moe and Curly.