LAS VEGAS--The exuberant atmosphere that so often characterizes Medtrade Spring was largely absent at this year's event, held last week in Las Vegas. But most HME providers who attended agreed the expo was the place to be for those seeking critical information on how to do business in an industry turned inside out.

About 7,500 people, some 1,600 of them manufacturers, turned out for the event, according to show officials. It was the first industry conference since CMS released its final rule on competitive bidding and an Aug. 31 accreditation deadline for providers in the 10 MSAs where bidding will roll out.

Questions about the two topics were pervasive, and providers frantic for answers crowded seminars covering the issues, often overflowing into the halls of the Las Vegas Convention Center.

"Competitive bidding is foremost in everybody's mind, that and the accreditation [deadline] coming up in August," said Sherman Mead of Golden Technologies in Old Forge, Pa. "They're trying to get a feel for what the reimbursement is going to be, the changes [coming up] and how they are going to affect their business."

"Everybody is trying to figure out how to stay in business," said Viola Jenkins, whose HME company, VitaCare Inc., is located in Dallas, one of the first cities where competitive bidding will debut. "Everything we do is in there," Jenkins said about the products included in the bid. "All of our products are going to be affected.

"Medicare is a huge percentage of our business," she continued. "We will bid; we're just trying to figure out how to bid. Should we bid directly or should we join a network?"

Seminar presenters were inundated with questions like Jenkins' and others about competitive bidding, ranging from the very basic "What is competitive bidding?" to "Should I even stay in the business?"

"People are trying to understand what this means for them and what they need to do in their business," said Mike Mallaro, CFO for VGM Group, Waterloo, Iowa. The buying group's booth drew scores of members and non-members alike, many of whom wanted suggestions for new niche markets and cash-only items they could tap into to shore up their bottom lines, he said.

While it appeared difficult for many providers to wrap their minds around the reality of what lies ahead for HME, Mallaro said, "I think most people are beginning to understand. But the devil's in the details."

And the details of the 401-page final rule--such things as the components of a bid, who can be in a network and how bids will be evaluated--are overwhelming for providers to absorb in such a short time, stakeholders said. After releasing the rule on April 2, CMS said it would try to open bidding by the end of this month (see today's top story for more).

"The [providers] I spoke to ... didn't understand competitive bidding at all," said Robert Thompson of DMETrain in West Springfield, Mass., adding that his booth was "swamped" with providers clamoring for information.

The topic of accreditation was equally confusing for those who flocked to accreditors' booths.

Susean Nichols of Millennium Management Services in Long Beach, Calif., said most providers were hoping for easy answers to their accreditation queries, but unfortunately, they were disappointed.

"They're trying to grasp onto the slightest bit of information like that's it. And that's not it. That's just the starting point," she said.

Christine MacDonnell of the Commission on Accreditation of Rehabilitation Facilities also noted that the issue was just "too new" for most providers, especially small company owners who had never before considered accreditation. "They don't know the questions to ask," she said.

Karen Taylor, a physical therapist with Dove Medical Supplies in Cheektowaga, N.Y., called accreditation "a little overwhelming," but added, "we better get it going." She and others from her company, including owner Loretta Carr-Stock, R.N., were checking out all the accreditors to find one that would suit their business.

"With competitive bidding and Medicare changing everything, it seems like everything is coming at once," said Carr-Stock.

While there were new products and new manufacturers on the exhibit floor to generate enthusiasm among providers looking for sparkplugs for their businesses, a number were still questioning whether, in the light of competitive bidding and mandatory accreditation, they would even stay in the business.

It was, perhaps, the biggest--and most disturbing--question of all.

"I think there will be people who throw up their hands and walk away," said Nichols on the last day of the show. "But this industry is built on the backs of small providers. So they can't go away."