It's amazing how optimism and pessimism can merge to form an uneasy alliance. As a record group of 350+ attendees assembled at last month's AAHomecare Legislative Conference, they encountered opinions, blunt assessments, and cheery predictions. After the speeches, they gamely scoured Capitol Hill with a largely unified message.

Following the unfavorable budget "scoring" of the any willing provider provision, most attendees ultimately decided to push hard for a delay of the first round of competitive bidding. After all, if you delay round one, you delay round two.

The folks from the Ohio Association of Medical Equipment Services (OAMES), pictured with Sen George Voinovich (R-Ohio), kindly let me tag along as they made their case. Unlike my previous four visits to AAHome-care's DC conference, we met with the actual Senator and not an aide.

With John Reed of PRO2 Respiratory doing most of the talking, Voinovich listened patiently but clearly did not want to promise too much. Eventually, he said, "OK, what do you want?" It isn't every day that you hear a senator ask such a tantalizing question. Sensing Voinovich's reluctance to overpromise, members of the Ohio delegation followed suit and resisted the temptation to overask. Eventually, they asked the senator to pen a letter to CMS Administrator Kerry Weems, to advocate for a delay of competitive bidding's round one, and allow for proper study of round one's effect on small business.

OAMES members convinced Sen George Voinovich (middle in blue suit) to pen a letter to CMS Administrator Kerry Weems.

Voinovich agreed and made good on his word, eventually signing a letter with 16 other senators. While the letter did not explicitly call for a delay, Weems could certainly choose that course. As editorial advisory board (EAB) member Tim Pederson pointed out, legislative pressure worked before when the industry asked for extensions during the submission process.

If Weems and CMS choose not to delay, then by the time you read this round one bidders will have almost surely received the news about whether they have won a contract or not. Three HME Today EAB members—Georgie Blackburn (Pittsburgh), Larry Rice (Dallas), and Joel Mills (North Carolina locations)—are all involved with round one, and we will be reporting on their experiences.

If the delay does not come through, it won't be for lack of fighting. With pertinent studies, in-person visits, and emphasis on small business impact, AAHomecare, NAIMES, and the state associations have fought well, and continue to fight. It has been an extraordinary past few months, with national media coverage casting an often unfavorable light on the industry.

As competitive bidding marches on, one wonders what it will take to expand the outcry and go beyond the industry champions such as (but not limited to) Voinovich, Sen Pat Roberts (R-Kan), and Rep Jason Altmire (D-Pa). "We may have to wait and see who gets contracts, and maybe that will personalize it more for legislators—because now it is all what if," says Pederson. "To get some real reform on this, there may have to be some blood."

Greg Thompson