Original blog here.
Sure. Here’s how Lewis Black might tackle the CMS OPPS and PFS Software as a Service (SaaS) comment solicitations — with his signature anger, disbelief, and sputtering, vein-popping frustration:
LEWIS BLACK COMMENTARY
“WHY DOES MY HEART RATE SPIKE EVERY TIME CMS TALKS ABOUT SOFTWARE?”
Ladies and gentlemen, I have spent hours — HOURS! — reading the CMS proposals on how they might, one day, in some distant utopian future, decide to pay for software. Yes, software. Not radioactive isotopes. Not nuclear submarines. Not platinum-plated MRIs. Software. The kind of thing your nephew writes in his basement for free while high on Mountain Dew.
But apparently, when software is used in a hospital or doctor’s office, it becomes so bewilderingly complex to Medicare that it might as well be a telepathic octopus running your EKG.
First, we have OPPS. That’s the Hospital Outpatient system, which is supposed to make things simple. Except CMS is asking: “Should we pay for software through the imaging bucket? Or the diagnostic bucket? Or should we create a new bucket made entirely out of invisible vapor? Because SaaS doesn’t really exist in a way we can hold or touch, and this upsets us deeply.”
Meanwhile, over in the Physician Fee Schedule (PFS), they’re still using a cost model built during the Bush administration. The first Bush administration. CMS’s PE (that’s Practice Expense, not Physical Education, though both involve sweating profusely) is based on categories like “equipment” and “supplies.” Software isn’t equipment. It isn’t supplies. It isn’t a thing they can point to and say, “I own that.” It’s a subscription fee, like Netflix for cardiology. But CMS can’t figure that out because they are still looking for the floppy disk.
And here’s where I blow a gasket: CMS thinks software should be paid differently in hospitals and doctor’s offices. Why? Because… bureaucracy. Because the software magically becomes worth less when you walk out of the hospital and into a clinic. I guess AI algorithms lose IQ points when they leave the building. Maybe the WiFi signal weakens their brain cells.
And God help us, they’re worried that paying hospitals properly for SaaS will set a dangerous precedent… Like what? Encouraging hospitals to use better technology? Enabling accurate diagnoses? Promoting efficiency? Oh no, we wouldn’t want that.
Then they ask, “What about the research and development costs?” Listen, CMS, you paid for Aduhelm. You paid for Relyvrio. If suddenly now you’re worried about being careful with how much you reimburse for software R&D, I need to sit down because my head is spinning.
Here’s the solution. Ready? Pay for software like it matters. Because it does. Pay consistently. Whether it’s in a hospital, a clinic, a submarine, or on Mars. Don’t ask for seventeen data sets that don’t exist because you refuse to recognize SaaS as real until 2050. Don’t tie payment to claims data that won’t exist because YOU NEVER PAID FOR IT IN THE FIRST PLACE.
And stop pretending this is a metaphysical debate about whether software is a ‘service’ or a ‘thing.’ It’s like arguing whether a sandwich is a food or an object while I starve to death in front of you.
That’s my comment. I’ll go cool off now. With software. Probably SaaS. Probably something you won’t pay for.
LEWIS BLACK
(American taxpayer, Medicare beneficiary in training, and unwilling SaaS philosopher)
