For years, the HME industry has dodged the bullet of competitive bidding. Some have ignored it, others have fought it. But now time's up, and it's high noon at the HME corral.

Competitive bidding is a reality, and along with new oxygen provisions set out in the Deficit Reduction Act, the legislative and regulatory mandates currently in place will change the industry's landscape forever.

HME's New Frontier will require new thinking and new business models to face down the challenges and, when the baby boomers become Medicare-eligible in a few years, to deal with a new generation of beneficiaries who have their own ideas about health care service and setting.

Is it time to give up? Absolutely not, say the advocates on the following pages, including congressmen, lobbyists, providers, manufacturers and others.

Now more than ever, they say, is the time to get involved in shaping the industry's future — and yours — by supporting legislative remedies that can protect your business and your patients.

Keep At It!

Cara Bachenheimer, senior vice president of government relations, Invacare Corp., Elyria, Ohio

To put it bluntly, Cara Bachenheimer believes the HME industry's best opportunity to affect substantive improvements to CMS' competitive bidding program lies with passage of the Medicare Durable Medical Equipment Access Act of 2007. Providers may be more familiar with the proposed legislation's common bill numbers and names in the House and Senate: H.R. 1845, also known as the Tanner-Hobson bill, and S. 1428, known as the Conrad-Hatch bill.

While Medicare provisions could come into play earlier as Congress debates funding and expansion of the State Children's Health Insurance Program, Bachenheimer says “we still have significant opportunity to [change things] now that we are hearing Congress … is inclined to consider and pass a Medicare package later this year.”

She explains that the push for a separate package of legislation that would address Medicare is driven primarily by lawmakers' desire to “fix” the physician payment formula to avoid scheduled cuts.

It would be in the industry's best interest if the competitive bidding bills could be attached to that larger package, Bachenheimer says.

But she adds accomplishing that feat means additional stakeholder support from among the industry's rank and file is a must.

If there is a Medicare package, Bachenheimer says, “we have the time and an opportunity to get enough support for the competitive bidding bills to get them attached to that package, which also means we need to increase the number of members of Congress who are official supporters of these bills. That would help considerably,” she explains.

“If we get 200 members of Congress to sign on to the Tanner-Hobson bill, it is likely to attract a lot more attention, and that will make it far easier for our allies like Reps. Tanner and Hobson to push to get the bill attached to the larger Medicare bill this fall.”

Bachenheimer urges providers “to contact their representatives and senators and urge their support of these bills. We all have our work cut out,” she says.

Small HMEs Needed for Quality Care

U.S. Representative David Davis, R-Tenn.

Home health care and HME are important to Rep. David Davis, personally and professionally. He fears competitive bidding as it stands will be harmful to both patients and business owners.

“Being a small-business owner, the reality is that it will harm the economy of local communities and will put small-business owners out of business, which could also lead to less quality of care,” he says.

Davis — a respiratory therapist who has served as chairman of the Tennessee Association for Home Care — is also worried about the consequences of the Deficit Reduction Act's forced transfer of oxygen equipment to beneficiaries.

“The idea of patients owning their oxygen equipment and being responsible for it is very disturbing to me as a respiratory therapist by training and the son of a mother with emphysema who was chronically attached to oxygen for five years,” he says. “If she had been without a company that had 24-hour emergency care, she would have stayed in the hospital many more days than she did before she passed away. I am very concerned about that.”

On a hopeful note, he adds that “the members I have talked to in Congress are open to listening to [these] concerns.”

But he also notes that providers must let their legislators hear how they feel about competitive bidding and the DRA's oxygen provisions.

Advises Davis, “I would recommend that the business members across America and their patients and physicians contact their member of Congress and let them know the ill effects that can take place if the industry changes from locally owned, community-owned, quality companies like we have had in the past.”