Bill Elliott, president and CEO, The MED Group, Lubbock, Texas

Anyone who has been in the HME industry in the last decade knows that predicting what Congress will do is impossible. That's why Bill Elliott says providers must diversify to become less reliant on Medicare business.

“Sometimes there are things in life that you don't control, and even if you have done all the right things, the government can still make an absolutely crazy decision,” he says. “We can't predict all the things that are going to happen. I can't predict how much of Tanner-Hobson, if anything, is going to come through. And frankly, I'm tired of hearing other people's opinions on it because their opinions are not any better than mine.”

Adds Elliott, “We know there are going to be winners and there are going to losers.” That's why he wants providers to be ready — financially and operationally — to succeed. “If you only have one product line and if Medicare is making up 30 to 40 percent of your business, it's pretty hard to sustain your company's business,” he says.

“If, however, you're more diversified, it gives you some opportunity to focus on … the private pay and the commercial business in the area that you didn't win with Medicare until that comes back around to you, because it will come back.”

John Gallagher, vice president of government relations, The VGM Group, Waterloo, Iowa

According to John Gallagher, “A lot of providers have kind of dropped off the radar thinking that [competitive bidding] won't affect them for a couple of more years, or that it is not going to affect them even after the first round is implemented.” But he points out that the pain could be universal. “Unfortunately, if there are enough erroneous bids, CMS can use [the bid pricing] for inherent reasonableness.”

Gallagher explains that if too many very low bids are submitted in the first round, “they will come back to haunt people in Peoria, in Louisiana and in the panhandle of Texas.”

That's one reason it just makes “common sense” that providers should support the passage of the Tanner-Hobson and Hatch-Conrad bills to get them enacted.

Amending the competitive bidding program to allow qualified providers to participate would benefit both patients and providers, Gallagher says. “Then there wouldn't be access issues for beneficiaries and small businesses would not have to go out of business.”

And, he adds, “we won't have crazy bidders in Miami setting the fee schedule that will be in the future for people in Utah.”

Rita Hostak, president of the National Coalition for Assistive and Rehab Technology and vice president of government relations, Sunrise Medical, Longmont, Colo.

Once national competitive bidding is implemented, says Rita Hostak, “there is no doubt there will be limited access” to some items necessary to meet the unique needs of individuals with disabilities.

“Newly injured clients may or may not be aware of the access problems because they don't have a strong knowledge of what technology had been available before,” she says. “But, aware or not, their function and independence will be negatively impacted by reduced access and standardization of products.”

Many in the industry's rehab sector also believe competitive bidding will limit access to providers.

“The rehab technology industry has never been one that attracted new people because of the profitability. People entered this market because of a strong desire to serve people with disabilities; many of the people in this industry have clinical backgrounds or family members with disabilities,” Hostak explains.

“However, reimbursement cuts and increased costs associated with the provision of these technologies are driving manufacturers and suppliers toward standardization of equipment. The ability for an RTS to assess an individual's technology needs and select equipment that truly meets their medical and functional needs and promotes independence and, equally as important, prevents further decline in function, is already threatened.”

Hostak adds that the first round of competitive bidding will further deteriorate the ability of those individuals in the first 10 CBAs to meet their goals. “National competitive bidding will change the service delivery model for rehab technology permanently — and the change will not be positive,” she concludes.

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