As I write this, the final day to submit bids for the first round of competitive bidding is just a few days away. I also realize that many of you wish the extension had never been granted in the first place. After all, providers have told me: "Why reward a bunch of procrastinating Johnny-come-latelies?" I understand the sentiment. You've been panning for gold for a long time. It doesn't seem fair that someone might stake a claim and strike the mother lode after prospecting for just a week.

However, as South Dakota provider Tim Pederson (AAHomecare's Rehab and Assistive Technology Council chairman) pointed out recently, the extension reflected a promising development. Legislators are listening to the industry, and pleading our case at the highest levels of government. Remember that Sen Pat Roberts (R-Kan) used most of his time at July confirmation hearings to grill CMS administrator nominee Kerry N. Weems about the technical problems encountered by many providers prior to the extension.

Meanwhile, CMS officials chant and toss bids into a bubbling cauldron—and providers await a decision that will fundamentally alter their destinies. In an attempt to cover the worst-case scenario, I asked the attorneys at Brown & Fortunato last month to come up with alternatives for providers who do not win a Medicare contract in December 2007. If you missed their sage advice, go to "Is There Life After Losing?."

While the archives are a great place to catch up on business issues, it's still tough to gauge the true effects of competitive bidding. In all the uncertainty, providers can at least take heart in knowing that the next round of 70 metropolitan statistical areas (MSAs) will likely proceed with the benefit of valuable lessons learned (hopefully).

For providers looking to sell their business and wash their hands of it all, the uncertainty has no doubt led to tepid buyer response. As one of our experts this month so aptly put it, "Nothing slows down the pace of acquisition activity more than uncertainty." See "Compliance: It's a Daily Thing" for our complete conversation with two eminent mergers and acquisitions experts.

As the competitive bidding cauldron simmers, the industry's legislative issues near a boiling point. By the time you read this, the September 30 State Children's Health Insurance Program (SCHIP) renewal date will have come and gone. Negotiations will have ended in compromise, or Congress will have declared itself at an impasse, and likely passed a continuing spending resolution. That would still leave the 18-month oxygen cap and the power wheelchair purchase option on the table. With many other challenges crowding the docket in Washington, DME issues may take a back seat for now, and that's not necessarily a bad thing. As Tim Pederson told me last month, gridlock (at least for now) may indeed be the industry's best hope.

Greg Thompson

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