Washington A trio of threats to the home medical equipment industry-home health agency consolidated billing, competitive bidding and inherent reasonableness-were the focus of attention when industry leaders gathered in late April for the Health Industry Distributors Association Home Care Washington Conference.

After a day of panel discussions on the issues with regulatory officials and a briefing on lobbying techniques, about 60 conference attendees were turned loose to meet with their representatives and win support in face-to-face meetings.

In addition, there were updates on surety bonds and supplier standards. HCFA will issue a proposed surety bond rule in June with a final rule late in the year or early next year. The bond will be for $50,000. A final rule on supplier standards will be issued in June or July.

The featured speaker at the two-day conference was Sen. Charles Grassley, R-Iowa, who told providers and distributors he was concerned with HCFA's competitive bidding demonstration project in Polk County, Fla., and how it might affect access to quality care, especially in rural areas.

He said proposals raised by the bipartisan Medicare commission will be an issue during the 2000 presidential election if not enacted as Medicare reform this year. He also said his staff would look into consolidated billing, which HIDA officials maintain is more problematic to the industry than competitive bidding or IR.

Other members of Congress addressing the conference were Rep. Dave Hobson, R-Ohio; Rep. Sherrod Brown, D-Ohio; and Rep. Charles Canady, R-Fla.

HCFA officials Sharon Arnold and Mark Wynn discussed the competitive bidding demonstration goals, but attendees complained HCFA is preoccupied with fighting fraud and abuse, and has put a priority on low price rather than quality. Invacare lobbyist Dave Williams said HCFA is "ignoring the costs of doing business with Medicare and using flawed logic."

Ed Wissing, former president and chief executive officer of American HomePatient, said industry members "spend too much time" worrying about competitive bidding when they should be focusing on defining their businesses. He cited respiratory provider Lincare's ability to prosper despite Medicare oxygen cuts.

"We're blessed we've gone as long as we have without it," Wissing said of competitive bidding. "Do I endorse it? No. But if it means some go out of business, so be it. Darwinism."

On inherent reasonableness, HCFA official Robert Wardwell said the goal is median price.

"I'd like to think you think we're trying to be fair," he said. "We're the largest purchaser in the country, and we're paying too much."

HCFA officials have told HIDA that seven or eight additional items are under review for Medicare payment reductions via inherent reasonableness.

Hobratschk said the cochlear implant is one of the products under review, but the others have not been specified. Adjustments to these products are not likely to proceed, he said, until implementation of the pending IR reductions, which await the outcome of a GAO investigation.

Lobbying efforts by attendees were hampered by unfortunate timing. The Columbine High School shootings in Colorado took place the first day of the conference, and politicians were focused on the tragedy the day lobbying meetings were set.

Like a veteran lobbyist, Dave Kinskey of M&M Home Medical, Sunnyvale, Calif., saw the bright side in the day's unavoidable results.

"Even with what happened, these politicians can focus on the job at hand," he said after meeting with a staff member from California Sen. Barbara Boxer's office. "And I see a shift from three years ago, when home care around here meant fraud. Not a gargantuan shift, but it's clear from talking to them that everybody's mad at HCFA. That's a shift in our favor."