Editor's Note

Bracing for a Storm

• By Elisha Bury
• May 01, 2007

Shortly after the final rule on competitive bidding was released, I was driving near Fort Worth, Texas, when the sky turned an eerie shade of gray. Not far in front of me, I saw a dark, funnel-shaped cloud heading in my direction.

At first I couldn’t believe my eyes. Sure, I know I live in Tornado Alley. And I knew the weather forecast called for possible tornadoes. But I’ve never lived in a place where tornados were a possibility, nor did I believe I would ever encounter one.

It wasn’t long before I realized the tornado was headed right for me. Though I wasn’t sure what to do, I exited the highway and hid under an overpass.

Sitting in the special Open Door Forum on competitive bidding the next week, I was reminded of this close encounter. Sure, I knew competitive bidding was coming and I knew it was bad. But it wasn’t until I heard the desperation in the callers’ voices and listened to their questions that I really understood what was happening. The industry is standing in the path of a tornado called competitive bidding, and it’s sure to wreak havoc on patient access and providers’ businesses.

Here’s what I’ve learned about responding to emergency situations:

1.    Do not hide under an overpass. Translation: Do not hide from accreditation. You may think you’re playing it safe by forgoing the costs and time required to become accredited, especially if you’re not in one of the first 10 MSAs, but competitive bidding will still come for you. If you wait, you might cause more damage to your business than you realize. By Aug. 31, 2007, all providers in the 10 initial MSAs must be accredited to participate in competitive bidding. Before long, however, all providers will need to be accredited to bill Medicare — even if you don’t plan to bill for items in those 10 product categories. You must still become accredited to keep the rest of your business afloat.

2.    Do not stay in your car. It might look like competitive bidding is on the other side of the highway, but it is unpredictable. It can change course quickly. Just because you’re not in one of the first 10 MSAs doesn’t mean you won’t be in the second round that’s not too far off. Today it’s 10 MSAs, next time it’s 70. Business as usual is the most dangerous course to take. You must get out of your comfort zone and find shelter to survive. Diversifying your business with a retail or cash sales component might also be a good idea.

3.    Do not try to outrun a tornado. Do not try to bypass competitive bidding. Instead, start working on your bids now. If confronted with a tornado, you don’t have much time to act. CMS is also not giving providers in the first 10 MSAs much time to prepare bids. Learn from this first phase. If you’re not in one of the 10 MSAs, now is a good time to start learning the process so you’ll have more time to prepare your bids in the future.

Already competitive bidding is taking its toll on providers in Respiratory Management’s hometown of Dallas. Metrocare Home Medical Equipment offered to show us a day in the life of a respiratory therapist. Because of the quick deadline on competitive bidding, however, the provider had to switch gears to devote every spare second to learn the bidding process and prepare bids. Two staff members generously granted a brief interview in their spare time — after hours, when they should have been sleeping. My suspicion is that as the industry begins to feel the effects of this detrimental program, all providers will have less time for education, outreach and clients.

I’ve learned that providers do not operate that way. The industry goes above and beyond the call of duty to take care of its clients. Even in the midst of certain destruction, the industry is still finding ways to get the job done. I believe that spirit is what has helped the industry survive this long and what will continue to make it resilient even in the face of competitive bidding.

This article originally appeared in the Respiratory Management May/June 2007 issue of HME Business.