It will take billions of dollars over the next 5 years to satisfy CMS and extract the wanted savings from the competitive bidding program—the exact amount remains inconclusive. I had heard $6 billion, but a reliable source tells me that without a firm number from the Congressional Budget Office, that figure is not necessarily accurate.

No one disputes that it's a tidy sum, but does the money have to come from competitive bidding? A week after Medtrade Long Beach, my ears are still ringing from off- and on-the-record chatter designed to answer this question. Despite grumblings that saw competitive bidding being "scrapped" in favor of across-the-board cuts to Medicare allowables, that possibility seems remote as I write this.

Competitive bidding is literally an act of Congress—put into motion by the Medicare Modernization Act of 2003. There is likely no political avenue to get the law repealed, but the delay is another matter entirely. However, the delay costs money, and the industry must come up with that money somehow. As for next year, one expert confirmed that there could be "opportunities for bigger things."

As for the delay in the immediate future, there has been no shortage of pressure on CMS, to be sure. In an article that appeared during Medtrade week, Rep Pete Stark (D-Calif) went on record with The Wall Street Journal as saying he'd like to see the competitive bidding program "scrapped." In the article, Stark said he felt action would be taken against the program, but indicated he was uncertain of whether it will be in 2008 or 2009.

The contentious questioning of CMS Acting Administrator Kerry Weems last month during hearings called by Stark was yet another example of that pressure. With Stark himself asking Weems what he had learned from round one of bidding, and what he might change in round two, Weems said, "I can't think of anything I would change." To this, Stark concluded with the memorable quote: "I think I've seen you're a useless witness."

During Tyler Wilson's Medtrade legislative update last month in front of a nearly full room at 7:30 in the morning, there was a clear attempt by the AAHomecare president to gauge the type of cuts providers might be willing to accept. How about 5%? Nearly all hands raised. How about 10%? About 70% of hands raised.

One attendee volunteered 0% as an option, but Wilson shot it down quickly. When the attendee made the point that HME providers were a tiny percentage of the Medicare budget and were unfairly picked on, the only response was that the industry must deal with the current realities.

Ultimately, that was a valid answer. The reality is still that round two (at press time) is going forward, and round one is amazingly still scheduled to go into effect on July 1, 2008. In talking with some extremely sharp providers who were unjustly denied bid considerations, these facts are all the more frustrating. Calls for a delay have not yet reached critical mass, but it sure feels as if a chain reaction is on the horizon. Stay tuned.

Greg Thompson