It’s widely known that pharmaceutical companies recruit the loyalty of doctors by offering them incentives, such as well paid faculty positions for seminars held at resort locations and other valuable benefits, with the understanding that the doctors will prescribe and promote the company’s drugs. There is little difference between those practices and compensation paid to a doctor for making referrals to a radiology clinic, a clear violation of anti-kickback laws. The result of the kickbacks in both situations is to siphon money from the healthcare system for the purpose of mutual enrichment of the participants in the arrangement without contributing to the needs of the patients. In fact, decisions made on the basis of financial gain have been shown to often disregard patients’ interests. If the law currently extends to prosecution of the doctor-pharmaceutical company arrangements, these kickback practices should be stopped and prosecutions should be brought. If somehow the law still permits the compensation arrangements, it should be changed to prevent them.

My suggestion really incorporates many previous suggestions into a larger plan for redesigning the selection, training and oversight of management within CMS. Year after year, we get our survey results which show that we are one of the worst federal agencies to work for, despite having one of the highest grade structures in the federal workforce. Management gathers and tries to determine what employees want or what perks can be provided to obtain better survey results—making CMS one of the “best places to work.” There isn’t anything wrong with this, except that the focus of the conversation is always what we can do for the employees. I think the change that needs to happen in CMS starts with leadership, and only then can it be expected to filter down to the employees. CMS has smart, hardworking employees and managers, but we, as a whole, have a few flaws. There is a lack of accountability in this organization. Finger-pointing, blame-storming and “throwing people under the bus” are common occurrences among various components in this organization. Leadership is every bit as guilty as employees on this one and in many cases; I think the behavior has “trickled down” from leadership and infected the employees. Communication in this organization, as with most large organizations, is poor and lacking. It is not just a cross component phenomenon, it is lacking between management and the very teams that they manage! People avoid difficult conversations in this organization, it is human nature, but it allows negativity and resentment to fester, and fester it has.
I believe that for employees to truly be happy and feel valued, they need to feel heard, they need to be involved in decision-making, they need to be listened to and feedback from them needs to not just be solicited, but acted upon. Respect for each other in the workplace has to be a given, not an option. Conversations must focus on how we find solutions to workplace obstacles and not on “who’s to blame.” In order for any of that to happen, you need to have management/leadership ranks who hold those values dear and consistently promote that behavior by modeling it and expecting it, from their team. Let me just say here, that my hands are by no means clean, I have learned many of these lessons the hard way, and continue to learn them. Earning the trust and respect of our employees will take time and a lot of effort, and this is the only way I can think of to start us off down that path.
CMS is structured in a way that promotes technical expertise into management. In order to get your 14, making you eligible for a 15 management position, you either have to be a technical advisor or a special assistant—neither of these positions insures, develops or promotes the ability to lead and manage. Consequently, what CMS has at its helm is largely a group of really great and hard working technical advisors, who may or may not have ever had any interest (or skill) in leading people. Add to that that CMS does not have a formal, structured management development program and while all managers must go through LINC (leadership in context) training, many don’t get to attend until they have been in management for several months (which is often several months too late).
There is also no formal structure for employees to provide feedback to their managers (i.e., a 360 degree review), so managers can remain blissfully unaware of the mistakes they are making with their team. Finally, many managers have been burned with EEO or other types of grievances and are fearful of dealing with problem employees, others just don’t want to be bothered because it’s “too much paperwork.” Allowing poor performance or misconduct lowers the morale of those employees who are following the rules and are working hard. They see their neighbors getting away with surfing the net, talking all day on personal calls, taking the extended version of lunch and they wonder why they are working so hard. After all, nothing bad happened to X, right?
So, for those of you that are still reading, what does all this mean…well, it means that CMS needs to make a firm commitment to the selection, development and oversight of its leadership. At a minimum, CMS should:
1) Create a “management track” GS-14. Certain divisions have deputy directors, others don’t. I suggest using those positions, pooling them for the agency and allowing a certain number of management development 14s. These 14s would be selected not for their technical expertise, but based on their interest in leadership. They would rotate through different divisions in the agency, working under a variety of CMS senior leadership who are committed to leadership development.
2) Management training would be more intensive and would occur BEFORE managers were given an actual team to lead. Emotional Intelligence, Crucial Conversations and LINC would all be required, at a minimum.
3) Managers would be subject to a 360 review bi-annually. Managers who continually received poor feedback or showed no improvement from year-to-year would be removed from the management ranks.
• The 360-degree review of a manager by their employees should be anonymous. This would avoid the potential for even sub-conscious retaliation by the manager.
• The 360-degree review should include a numeric rating as well as the opportunity for employees to provide written narrative to explain the basis for their rating on any element. Any manager that gets a combined, overall rating from all their employees below a certain numeric value is flagged (it may be a good idea to throw out the highest and lowest ratings when calculating the overall value).
• Managers who receive an overall rating below a certain numeric value should be subject to PIPs based on the results of the 360-degree review.

4) Every Manager’s PMAP would include a “leadership” element; this would include developing and leading staff, as well as dealing with problem employees and working to rectify such situations appropriately.
5) If an employee or employees report that a manager yells or uses abusive/foul language when talking to employees or other managers, that manager will be warned once. If the unprofessional language occurs again the manager will be removed from their current position and barred from any leadership/management position (including that of team leader). The agency should communicate (and enforce) a clear, zero-tolerance for unprofessional/abusive language on the part of managers (and all employees, really).
6) Once the management 360 is implemented, it should be implemented for employees as well. The goal of this not so much to allow employees to “rate” one another, but to provide an avenue where co-workers can provide constructive feedback to each other. Employees would need to solicit feedback from their managers and their co-workers and would be expected to be responsive to that feedback as well. This would include adding an element to all employee PMAPs on being receptive to feedback and responsive to it as well.
I’m sure there is probably more that needs to be done, but I think this is the minimum that would need to be implemented to get us on the right track. Obviously, this suggestion will make some managers and some employees very upset, but I think those that will be most bothered by these changes are those that have no real interest in improvement, (luckily, I believe this is a small minority in CMS) and unfortunately, sometimes progress takes a few casualties.