ATLANTA--CMS issued item weights and product utilization data last week for round one of the national competitive bidding project, but the agency missed its "by the end of April" deadline for issuing the request for bids.

According to its Web site, "CMS has extended the target date for opening the bidding window to early May."

Still, the new information offered some tools for providers who plan to go after Medicare DMEPOS business in the 10 MSAs where competitive bidding will debut in April 2008.

"We are still evaluating the limited quantitative data that has been made available to the industry by CMS," said Lisa Getson, executive vice president, governmental relations, investor services and compliance, for nationwide provider Apria. The Lake Forest, Calif.-based provider has branches in nearly every competitive bidding area.

"No one has seen a bid document," said Tom Mullaney, president and owner of Mullaney's Pharmacy and Health Care in Cincinnati and president of the Ohio Association of Medical Equipment Services. Consequently, he said, there are "a lot of questions and concerns" that have stymied some providers' decisions on whether or not to bid.

For his part, Mullaney said, "we do all the categories currently, so we are going to bid all those."

Beth Bowen, executive director of the North Carolina Association of Medical Equipment Services, said that while most of the providers she has spoken with plan to bid, she's been getting all kinds of questions on bidding from less-informed providers throughout her state and beyond.

"They're asking everything from 'How long has this been around?' to 'What is competitive bidding?'" she said. "Those [questions] are very frightening because it's those kind of folks who are going to screw up the bidding process."

Even without all the answers, providers are scrambling to get ready. When CMS does issue the RFB, the agency has said its bid window will remain open for 60 days.

"We've been preparing for it operationally for the last year, just really looking at our procedures, our policies and efficiencies and trying to streamline areas that can be streamlined," said Tammy Zelenko, president and CEO of AdvaCare Home Services, Pittsburgh, and vice president of the Pennsylvania Association of Medical Suppliers.

AdvaCare will bid, she said, but not on all product categories. "My biggest concern is that even though I bid four categories, I may only get one of the four. And what does that do to the referral source and the beneficiary? It's going to be challenging for the hospitals discharging the patients and the beneficiaries. There is not going to be that continuum of care that we have worked so hard to achieve."

Progressive Medical Equipment in Lenexa, Kan., also has been preparing for some time, said owner Gerald Sloan. The company is just waiting for the RFB. "We're ready to go from the requirements standpoint," he said. "For the last several weeks, we have been assembling our prices on all the products."

It's been a sobering exercise. "I don't know where the savings are going to be," he said. "We're working off allowables that have been cut far, far from the allowables five years ago."

Sloan is concerned, too, that even a low bid might not be enough to keep Medicare's business. "There's so much subjectiveness to this. Honestly, we could give the lowest bid and not be chosen," he said. "They are going to look at our financials and consider if we are worthy of being in the Medicare program. If CMS decides they don't want you in the program, they can make that conclusion."

Raul Lopez, director of operations for Bayshore Dura Medical in Miami Lakes, Fla., and president of the Florida Association of Medical Equipment Services, recognizes the reality is that everyone who bids will not win. "We may not get everything, but we are going out there and we are taking a look at it," he said. "We have a lot of people who rely on us. We owe it to them to try."

Chris Rice, director of marketing for Riverside, Calif.-based Diamond Respiratory Care, said he is worried about how providers will compute their service capacity, one of the requirements of submitting a bid.

Rice asserted that overstating capacity would result in lower reimbursement. His worry is that providers will think that even if they only cover 2 percent of an area, they should write down, say, 10 percent. "They're going to think of it as an inert number. And really, it's the key to the whole system," he said.

"Imagine a ladder that has the bids arranged from lowest to highest (lowest on bottom). Each step is one provider's bid," he explained. "On the left side of the step is the bid price; on the right is estimated capacity. The more steps that Medicare climbs before it gets to 100-percent capacity, the higher the bids will go and the more reimbursement will be paid.

"If those capacity numbers are exaggerated," Rice continued, "they're not going to climb many stairs ... so when they select the reimbursement number from only a few of the lowest steps in the bidding staircase, reimbursement is smaller than it should be."

Sandra London-Leib, CEO of Advanced Homecare in Lawrence, Kan., believes that it will be the patient who, in the end, is most adversely affected. Her company will bid in multiple categories, she said, but she fully expects a negative impact on Medicare beneficiaries in the Kansas City CBA no matter who wins. "We anticipate being able to weather this storm, but the cost of survival will be great and the patients in rural Kansas will be the ones hurt the most when all is said and done," she said.

"The best thing that could happen," she added, "is for competitive bidding to be delayed a couple of years so that Congress could actually examine the plan and understand the possible repercussions of their actions on America's seniors and disabled citizens."

That's something Mullaney is fighting for. "I'm lobbying to get it stopped or repealed," he said bluntly.

To link to the Competitive Bidding Implementation Contractor Web site, click here.