Sighs of relief mixed with groans of displeasure throughout the industry last month when CMS revealed the next 70 MSAs for round two of the competitive bidding program. The sighs of relief came from those large cities that were spared the headache of preparing a bid. Seattle, Phoenix, and Philadelphia are but a few of the many sizable areas that avoided the CMS darts.

Despite two lawsuit attempts and legislative monkey wrenches such as HR 1845—which is far from dead—the juggernaut of competitive bidding marches on. At press time, however, the nitty-gritty details for round two are not available. When does registration start? Don't know yet. Ditto for when the round two bidding process will begin and end. As Joel Kaiser, CMS deputy director of DMEPOS policy, so memorably put it at a recent open-door forum, "We will have a detailed timeline when we're ready to have a detailed timeline."

Is it wise to start round two when the effects of round one are unknown? Probably not, but CMS is obligated by law—albeit with discretion—to lurch forward. To providers such as Tim Pederson, CEO of WestMed Rehab Inc, Rapid City, SD, the move shows a lack of prudence. "I think they [CMS] haven't learned a thing from the first round of competitive bidding," laments Pederson, an editorial advisory board (EAB) member for HME Today who also serves as chair of AAHomecare's Rehab and Assistive Technology Council. "The reason they didn't have New York, Los Angeles, and Chicago in the first round is that it would have been too cumbersome for them to manage. Now they are going to include them with 67 other Metropolitan Areas. I don't think that will make it any easier."

Meanwhile, the legislative honeymoon crumbled quickly when senior staff from two Congressional committees confirmed that oxygen therapy and DME were at the top of the list for Medicare reimbursement cuts in 2008. Responding to this sense of urgency, HME Today EAB member Georgie Blackburn, vice president of Blackburn's Physicians Pharmacy, Tarentum, Pa, invited Congressional Rep Jason Altmire (D-Pa) to her place of business (see photo) to discuss competitive bidding's impact on small business.

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A reporter from the Pittsburgh Post-Gazette covered the visit and the article was a nice change from the barrage of bad publicity endured over the past few months. "As more and more baby boomers join Medicare, it is clear that we need to look for common sense ways to cut costs," said Altmire in the Post-Gazette article. "However, CMS' new competitive bidding program could force thousands of small medical equipment suppliers out of business, costing hard working Americans their jobs and depriving Medicare recipients of valuable, personalized care. This could have a particularly devastating effect on the Pittsburgh area, which is home to hundreds of small medical equipment suppliers."

Not a bad quote, eh? It's clear that Altmire "gets it," and it sure sounds as if he will likely support the industry in the coming months and years. Providers who take the time to invite Senators and Reps rarely report a bad experience. In 2008, 435 Reps and 35 Senators are up for reelection. If providers can make competitive bidding an issue that resonates with older voters, lawmakers will listen."

Greg Thompson