Most importantly, HR 1845 would allow any willing HME provider who complies with all requirements to participate at the competitively bid rate.

Perhaps its release on April 2 was a bit too close to April Fools' Day, but CMS' final rule implementing the competitive acquisition program for DMEPOS items is no joke. And the April 1, 2008 implementation date will be no laughing matter either.

For those providers who have been hoping it would just go away or not impact your business, this is your wake-up call. To change the course of events, the active involvement of HME providers across the country is needed—NOW! The industry must effectively engage consumers, clinicians, and referral sources in a focused effort to get the Tanner-Hobson bill passed into law.

The Tanner-Hobson bill (HR 1845) was introduced March 29, 2007, by Reps Dave Hobson (R-Ohio) and John Tanner (D-Tenn). It would alleviate many of the ill effects of the competitive bidding program. (At press time, Sens Conrad [D-ND] and Hatch [R-Utah]) were planning to soon introduce the companion bill in the Senate.) Most importantly, it would allow any willing HME provider who submits a responsible bid and complies with all the bid program requirements (quality standards/accreditation, financial standards) to participate in the bid program at the bid rate for the item.

Perhaps second most important is the provision that would require CMS to demonstrate the likelihood of achieving at least a 10% savings before a product category could be included in the bid program. The most important improvement to this year's bill is that Congress would have to specifically authorize CMS to implement competitive bidding beyond the initial 10 metropolitan areas, before CMS could expand the program into more cities and states.

If you are still not convinced to take action, the following six reasons may change your mind:

1. If a provider does not win the bid contract for the 3-year contract period, they will not be able to provide products to Medicare beneficiaries in that metropolitan area for 3 years. Can any business survive that?
2. The "small business set-aside" of 30% of winning bidders for each of the bid areas is limited to companies with $3.5 million or less in total annual revenues. Reversing its position, CMS deviated from the Small Business Administration's definition of "small business" as one with $6 million in total revenues. CMS reserved the small business set-aside for those providers least likely to be able to survive in a competitive bidding environment.
3. Home oxygen equipment is included as a product category, despite the extensive service needs of this consumer population. Unrealistically low bids will come at the expense of service, and service cuts mean lower quality of care and less favorable clinical outcomes.
4. High-end rehabilitation and mobility products are included as a product category. Again, a service-intensive series of items that are custom-fitted to the individual's specific needs is perhaps not the best pick for a bid process. How do you calculate costs for a product category where one size does not fit all?
5. The bid price for each item will be established at the median bid price of the winning bidders. This means that half of the winning bidders will be paid less than their bid amount for the item—if they choose to become a contract supplier.
6. Providers across the country in every single state will be impacted when CMS exercises its authority in 2009—only 19 months away—to apply bid rates from the bid areas to the same items in nonbid areas. Therefore, the industry can expect reductions in these product categories across the country, including rural areas where the cost of service is highest.

While the industry already has some good support for HR 1845 in Congress, sponsoring Representatives and Senators need consumers and clinicians to join the industry in lobbying every member of Congress in their home districts and in Washington, DC.

Looking for guidance? The leaders of the industry are unified and so is the message. Talking points, draft letters, and background information are available through the American Association for Homecare at www.aahomecare.org; and through other industry resources.

The time is long past when this fight can be left up to the "other guy" or the trade association. Every person reading this column has an obligation to take immediate action. Write a letter to your Reps and Senators urging them to sign on as cosponsors of HR 1845. Put together a fact sheet and draft letter to include with every delivery to your customers. Talk to your friends, neighbors, and relatives and encourage them to write or call their representatives today.

The HME industry cannot outspend the interests that are competing for attention and funding in Washington. The only path to victory demands that the industry and its allies outwork them.

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