“CMS is moving forward with implementation of competitive bidding for some products in large metropolitan statistical areas (MSAs) in 2006. The HME services industry cannot afford to allow this to happen, and a full-scale assault on Congress must be planned on this issue alone.”

Happy new year! Hopefully, your holiday celebrations were not dampened by the prospect of regulatory and legislative challenges that lie in front of the HME services industry. The 109th Congress of the United States has been sworn in, and President George Bush’s inauguration for a second term is history. The margin of victory in the presidential race, coupled with expanded Republican majorities in both the House and Senate, will embolden some members to pursue a more ideologically conservative agenda. Further, many pundits predict that the philosophical gap between the House and Senate is greater than ever. This means everything will be difficult and compromise will rule the day on almost every issue.

The HME services industry starts the year in a deep hole. At least three major issues threaten the health and welfare of many providers—and there is much work to be done.

Federal Employees Health Benefits Program (FEHBP)-based pricing is the most immediate challenge. The good news is more than 115 members of Congress signed on in 2004 as cosponsors of HR 4491 that would have eliminated the shift to FEHBP-based pricing for eight categories of HME products. The bad news is that the legislation did not pass before adjournment of the 108th Congress, and now the process must start over. That means that Rep Dave Hobson (R-Ohio) must reintroduce the bill, cosponsors must once again sign on, hearings must be scheduled, and the issue must move through committee to the floor of the House. In the House it must receive a majority vote and then be forwarded to the Senate for action. In short, this means it will be at least 6 months before this issue is resolved. During that time, CMS must make the reductions as stated in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

In the meantime, CMS is moving forward with implementation of competitive bidding for some products in large metropolitan statistical areas (MSAs) in 2006. The HME services industry cannot afford to allow this to happen, and a full-scale assault on Congress must be planned on this issue alone. This means gathering solid data that refutes the Congressional Budget Office estimates of what competitive bidding will save. Further, the industry must build strong alliances with other interested parties that do not want to see competitive bidding become part of Medicare. Hospitals, physicians, and allied health professionals such as physical and occupational therapists, speech therapists, and respiratory therapists must be brought to a point where they will express their objections to competitive bidding. Consumer groups also need to be educated on the consequences of this proposal.

CMS is moving ahead with its effort to clarify the HCPCS coding system, and this activity will have a tremendous impact on rehabilitation providers and, eventually, on all HME providers. The industry must remain actively involved as this effort moves forward.

As if our plate were not full enough, President Bush will submit his budget recommendation to Congress in early February. Conservatives in his own party are going to apply great pressure to reduce the deficit—and this is an extremely difficult task in light of the ongoing expense of the occupation of Iraq. Further, the president has expressed his desire to implement, at least as pilot projects, some new domestic policies. Thus, existing programs such as Medicare will be under intense pressure to reduce spending. This type of pressure is always a threat to the HME services industry.

There are HME providers who are tired of fighting Washington and ready to throw in the towel. Let them go. The battles ahead will be fierce and can be won only by dedicated, committed warriors. This is not the time or place for the faint of heart.

The number of political professionals working on behalf of the HME services industry continues to grow. Every effort should be made to ensure that each of these individuals is always on the same page, focused on the same target, and delivering the same message. This may be the most difficult year the HME services industry has ever faced. Worse yet, whatever is accomplished this year will only make the challenges of 2006 even greater. The industry has clearly reached the point where if you are not with us, you are against us.

Cara C. Bachenheimer, JD, is vice president of government relations for Invacare Corp, Elyria, Ohio. David T. Williams is a consultant for political and legislative strategy.