On what happens now:

"The most disturbing thing is that CMS' implementation plans for Round Two will ensure that they are not able to make any adjustments in Round Two based upon impacts of/lessons learned from Round One. That seems counter to Congress' intent, which provided for a two-year span between the implementation of Rounds One and Two. Congress purposefully required CMS to roll out such a massive program in multiple phases so they would be able to learn from their own experience. Just because CMS got behind in implementing Round One doesn't mean the rest of the country subject to Round Two should suffer."

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

"As hard as we've worked, we've had little or no effect on the mentality of CMS and how they're going to roll forward from here--and they're going to roll forward by rolling right over us."

--Jason Rogers, president, Care Medical, Athens, Ga.

"I don't have a sense yet of how, if you get paid less than you were getting paid, you could offer anything but less service and quality. The patient's co-pay may shrink with the degree that the bid price shrinks, but it will be at a cost of getting low-quality products and no service."

--L. Jack Clark, RRT, founder and principal, Mid Georgia Respiratory, Macon, Ga.

"If the government continues to tighten the requirements just to file a Medicare claim, the patients will be the real ones to suffer because there will be limited access to care. It is almost unaffordable to provide service in an environment when we have to add layers of employees just to comply with rules that bring us the same or less money than we've received in the past. The real question is: When do we get to tell our side of the story? I'd be happy to inform CMS about the good work done for patients who would otherwise go without. When disasters strike, I've never heard of a provider saying no, even [though] they do not earn one dime more for their valiant efforts. Well, maybe we should rephrase it--maybe they haven't had to say no just yet!"

Miriam Lieber, Lieber Consulting, Sherman Oaks, Calif.

"I think right now the way it's headed, it will be negative. CMS is moving much too quickly. There was a great deal of difficulty in Round One and, now, without even taking a pause to learn from that experience, they're going forward and expanding seven-times plus."

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

"I am very concerned about the impact on the industry. Am I worried enough to give up the ship? No."

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

"To begin, the 'Armageddon' predictions offered by some industry stakeholders shortly after the MMA was published will not, in my opinion, occur. While there will certainly be some significant Round One reimbursement reductions, providers serving the Round Two areas have the relative luxury of sufficient time to prepare for the 2009 contracts ... With that said, if I was asked whether there will be a large number of Part B suppliers who will cease serving Medicare beneficiaries or perhaps go out of business, the answer is yes. But there are over 100,000 active Medicare Part B supplier numbers. The number of full-line HMEs and other DMEPOS companies servicing beneficiaries on a regular basis is much smaller--less than 20,000. Of these, while acknowledging many will be affected in some manner by competitive bidding, the great majority will continue their quality home care services as before. Many will reap the benefits of increased business."

--Mark Higley, vice president of development, VGM Group, Waterloo, Iowa

"I am very bullish on the industry, and I think it's going to continue to grow. Let's not be pessimistic. I think we have the right to be optimistic. Simply, the landscape has changed; we're having to play by new rules. Change is always traumatic, but if we are proactive and aggressive and as long as we're not scared of our own shadow, I think the well-run HME business--whether it's a major or a regional or a mom-and-pop--is going to do very well."

--Jeff Baird, chairman of the Health Care Group, Brown & Fortunato, P.C., Amarillo, Texas.