ATLANTA--Mandatory accreditation and Round Two of competitive bidding have been on the industry's radar for months, but the whirlwind of recent CMS announcements detailing dates and deadlines nevertheless stirred stakeholder reaction.

While the deadline for Round Two accreditation has not yet been given, shortly before Christmas CMS set Sept. 30, 2009, as the "drop dead" date by which all DMEPOS providers must be accredited. On Tuesday, the agency followed with the list of the next 70 MSAs that will be included in phase two of the bid.

To some, including Cara Bachenheimer, vice president, government relations for Invacare Corp., Elyria, Ohio, CMS' list of the MSAs selected for inclusion came as a surprise.

"Some major metropolitan areas are omitted--Boston, Baltimore, Washington, D.C., and Seattle--and CMS is including some very sparsely populated MSAs. There is no information about why CMS selected these MSAs and omitted others, aside from the criteria in the final rule, so we may well never know the more specific selection criteria," she said.

Consultant Wallace Weeks of Weeks Group, Melbourne, Fla., was also surprised at the cities that were chosen. Weeks had worked up a forecast of cities that would be targeted in Round Two based on the selection criteria CMS outlined, "but my forecast was very wrong," he said. "Only a little over 60 percent of the MSAs I forecast were on the final list."

However, Weeks continued, "It is good that CMS has announced as early as they have and that the initial bidding process doesn't begin until winter of this year. I think that the list of MSAs treats the industry as a whole better than I had forecast. If they had gone for the larger MSAs like Boston, Philly, Phoenix and Seattle, there would have been a larger impact on the industry."

Weeks said the fact "that a mail-order bid for diabetic supplies is postponed is also a plus for the industry." While those products are excluded from the second phase of the bidding program, CMS said it is planning a national bid for these items with details to be announced later.

At a conference on competitive bidding sponsored by the Georgia Association of Medical Equipment Services, held in Atlanta just two days after CMS' Jan. 8 Round Two announcement, many providers said they were ready. Some, however, said they were concerned that results from Round One of the bidding program were still unknown.

Others, like Tim Pederson, CEO of WestMed Rehab in Rapid City, S.D., said the HME industry should know by now that it must be prepared for anything. "Providers that are prepared will do OK. Providers that aren't prepared will be hitting the panic button," he said.

But ready or not, competitive bidding is moving forward, and its final outcome is, at least at this point, still anybody's guess.

In the wake of the recent announcements, here's what stakeholders had to say:

On accreditation:

"Accreditation is a given, and it has been for a while. Anyone who is going to be in this industry should be accredited or should be in the process. If you're not well on your way, get started tomorrow!"

--Don Clayback, vice president, government relations, The Med Group, Lubbock, Texas

"My initial reaction is that we are going to have to organize time for the providers. In other words, we're going to have to catch the information up front: Are you being accredited for a fraud demo deadline? Are you being accredited for an MSA deadline? Are you looking for accreditation by September '09? From there, we can give [providers] deadlines. If you need to be accredited by whatever the MSA date is, you have to be finished with your work by this date in order to get your survey in on time."

--Mary Nicholas, executive director, Healthcare Quality Association on Accreditation, Waterloo, Iowa

"Mandatory accreditation is going to eliminate 80 percent of supplier numbers. We'll probably lose 90,000 [suppliers] from accreditation. The accreditation is going to be what causes the eliminations. And with the losses of all these small providers, access is going to be affected--it has to be."

--Wayne Stanfield, president and CEO, National Association of Independent Medical Equipment Suppliers, Halifax, Va.

On the MSAs chosen for Round Two:

"I was surprised at the omission of certain geographic areas. Some large cities were not represented on that list, like Philadelphia, Seattle, Portland, St. Louis. That was surprising to me ... It's almost like [CMS] threw darts at a map."

--Tim Pederson, CEO, WestMed Rehab, Rapid City, S.D.

"The interesting part is the cities that were listed ... I wonder what [CMS'] methodology was. I think it caught a lot of people off guard. Some people are going to be amazed that they are included."

--Mary Ellen Conway, president, Capital Healthcare Group, Bethesda, Md.

"Out of the top 10 MSAs, only No. 5--Philadelphia-Camden-Wilmington--and No. 8-Washington-Arlington-Alexandria--are not included. A very calculated move, so Congress won't have to hear complaints from providers and beneficiaries in their own backyard."

--Rob Brant, general manager, City Medical Services, North Miami Beach, Fla.