2008 is destined to be the year that the industry's long-standing predictions about competitive bidding either come true or not. Since 2003, when Congress passed the Medicare Modernization Act with its mandate that CMS implement the ill-devised and so-called "competitive acquisition" program, we have been bemoaning the ill effects of this program. With the imminent release by CMS of the winners and bid prices in the first 10 metropolitan areas, and bidding in the next 70 MSAs scheduled to begin this summer, we will begin to see the real-life impacts that this program will have on seniors and people with disabilities.

Perhaps the most egregious implementation decision by CMS was to include high-end rehab and assistive technology items in the bidding program. It is difficult for those in this business to imagine how consumers will fare when rock bottom bid prices are set for complex items. For many valid reasons, we have been trying to convince Congress to require CMS to exclude these items from the bidding program through support of HR 2231, the Rehab Carve-out bill introduced last year in the House of Representatives.

If you are in the business of providing consumers complex rehab and assistive technology, you readily understand that people with disabilities need explicit protection from the impact competitive bidding would have on their ability to receive appropriate items of high-tech rehab and assistive technology—and receive appropriate evaluation, fitting, follow-up, and service. Our challenge is to educate Members of Congress, who are unfamiliar with not just the items and services provided, but, more importantly, the consumers and their series of individualized needs that require extreme customization. This is not cookie-cutter stuff. Undoubtedly, the best way to educate Members of Congress is through consumers themselves. Words take a back seat when a Member of Congress meets a consumer with complex needs. The visual is typically all it takes for policy-makers to understand why these items are inappropriate for the bid process, and to enlist their support of HR 2231.

Competitive bidding is not appropriate for high-tech rehab and assistive technology. By nature, rehabilitation providers have a unique business model that involves a high level of personal involvement between the provider and consumer, and the integration of licensed health care professionals throughout the process. The bidding program will inevitably result in DME suppliers reducing services and selecting products based on cost, not appropriateness—simply due to financial realities. A reduction in services or limitation of products based on price alone will have a severe negative impact on clinical outcomes associated with the provision of high-tech rehab and assistive technology.

While Congress mandated the implementation of a system of competitive bidding for DME, the same law gave the Secretary the authority to exempt certain products from competitive bidding when "the savings would be inadequate to justify the administrative costs or when competitive bidding may have an adverse impact on the quality of care for Medicare beneficiaries." This language underscores the intent of Congress that competitive bidding be used judiciously. CMS has included high-end rehab power wheelchairs and related accessories in the bidding program, not choosing to exercise this authority. Congress should intervene and pass HR 2231.

There is a real need to exempt complex rehab products due to the potential negative impacts on individuals with disabilities who rely upon the sophisticated technology to be mobile and improve the quality of their lives. The truth is that quality will suffer and may cause reverse discrimination. Many suppliers are fearful of losing Medicare business for 3 years—which could mean shutting down their business in its entirety. Therefore, they will seek out lower cost items to establish a formulary for purposes of submitting a bid. The selection of lower cost items to be provided to all clients, not just Medicare beneficiaries, will result in a lack of access to products with many of the features that improve the functional capabilities of individuals with disabilities.

You have no choice but to rise to the challenge today. Take a consumer to visit your Senators and Representatives. The consumer can best explain the impacts of the bidding program on their ability to receive high-quality services and items. If you don't rise to the occasion and educate your Members of Congress, we and the consumers we serve will suffer.

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