Dana Picard of Coral Springs, Fla, is like many providers with the bad luck to be in one of the first 10 MSAs. She feels like a guinea pig and fears the consequences of not winning the magic competitive bidding contract.

As the owner of an accredited, 15-employee company called Diabetic Solutions, everything she does (mail-order diabetic supplies) falls under competitive bidding. "With no contract, we would be close to closing our doors," says Picard. "We would have to let go three fourths of our staff, and that is scary because you have loyal people working for you."

Unlike many mail-order diabetes suppliers, most of Picard's customers are local. If she someday uses her own trucks to deliver the supplies (instead of UPS), she would fall under "non-mail-order" diabetic supplies and not be subject to the competitive bidding program. Isn't mail order cheaper for all concerned? But wait, logic has no place in this discussion.

Incidentally, when Picard e-mailed the CBIC to get this clarification, it took them 2 weeks to respond. I have called the (877) 577-5331 CBIC number posing as a provider, and so far I have received good service—so perhaps the phone is the way to go.

In addition to Picard, I met many other nervous providers at Medtrade. Those who were not in the first 10 MSAs were noticeably relieved, but they too were looking for ways to avoid what is increasingly looking like a complete mess. What will the mess look like in the months to come? Well, some luminaries are getting set to hurl some serious monkey wrenches. One option under discussion among the heavy hitters at VGM and Brown & Fortunato (B&F) is a challenge on constitutional grounds. "The program is a train wreck in progress," says Jeff Baird, JD, of B&F. "I don't see this as being workable at all. The more I read about it, the more dismaying its prospects appear. It's almost on the level of a farce."

Yet another challenge came on May 9 when Rob Brant, co-owner of City Medical Services, North Miami, Fla, filed a formal complaint to the Small Business Administration (SBA) ombudsman, saying that the competitive bidding final rule fails to comply with a Congressional mandate to protect small suppliers. I spoke with Mr Brant just before we went to print and his energy is contagious. Brant is working with VGM to collect complaints via e-mail. All who are interested in joining him are encouraged to contact him at .

Brant and others are mounting these efforts because the fine print of the final rule does not favor small providers. The FAQ section at www.dmecompetitivebid.com says it clearly in response to the question: Can a supplier accept the single payment amount even if the supplier's bid was not in the winning range? The published answer is: "In general, no. However, if a supplier is a small supplier, it could be offered the opportunity to become a contract supplier if it qualifies through the small supplier target process."

Ultimately, providers must continue the balancing act of playing the game (see "Submit a Winning Bid" in this month's issue) while simultaneously trying to rewrite the rules. A third option is to cancel the game altogether due to inclement weather. Stay tuned in the stands.

Greg Thompson