This month’s HME Insider is James E. Walsh, Jr, president of Van G. Miller and Associates Management, and general counsel for the VGM companies, Waterloo, Iowa. Dealer/Provider asked Walsh about the major issues that shaped 2004.

You once referred to the MMA as the “financial equivalent of a hydrogen bomb for most HMEs.” Do you still feel that way?
Yes, I do, but I’m not saying that we can’t defuse it. This is the first time in health care that the government is attempting to set prices. They are saying that we don’t trust the system to set prices, so we are going to set them ourselves. That is what the competitive bidding law is going to do—set prices—and I don’t know where it ends. When it started, the attitude was, “Why should the government pay more for health care than it is supposed to?” Well, that is fine, but where do you draw the line? Because the whole idea behind a bid is to find who will pay the least for it, and once they find that entity, everybody else is out of business. Where do they go from there? The government is anointed a survivor and you end up with one provider.

We are still hopeful that we can stop the program, and we are going to continue that effort. If we can’t stop the program entirely, we are going to make sure it is arranged properly. We have a representative (Dave Kazynski) on the Program Advi-sory and Oversight Committee. If Medicare does this in a way that is destructive to the free market system, we are going to make it well known.

Do you think that CMS will officially appeal the Maximum Comfort case?
The scuttle right now is that they are not going to appeal it, but that is just rumor— so who knows? All they would need is one line in legislation that would say, in effect, that CMS could look beyond the certificate of medical necessity. If they don’t appeal it and don’t get a legislative fix, they have already been shown that this ruling is going to get thrown in their face in every appeal. It has already been used successfully by appelates saying to administrative law judges that these exact same issues have been addressed in California—and here is the considered and detailed ruling. What does CMS have to say when that is brought up? “Oh no, that ruling is wrong?” Well, why didn’t you appeal it then? If it is wrong, you should appeal it.

VGM has just introduced its National Respiratory Program. How can the program strengthen the market position of independent providers?
Independents have an advantage over the nationals already and they have proven it by staying in business. The market share of independents is going up. But when we find areas where nationals have been able to out-market our members, we do something about it. We will have resources and materials for independents to use in their communities to market respiratory products.