Stick with Wayne

When the going gets tough, the tough get going.

When life gives you lemons, make lemonade.

When you come to a roadblock, take a detour.

Aw, heck, who am I kidding? The chips are really down right now, and there are absolutely no inspirational platitudes that can help.

On April 2, HME’s worst nightmare turned into a reality: Competitive bidding has arrived in a 401-page final rule from CMS. One provider I spoke with said the only sure way to stop it now would be if nobody bid. I’ll bet even the Dallas Cowboys cheerleaders couldn’t put a positive spin on this situation.

The most devastating legislation/regulation in the industry’s history — and there have been some major baddies — CMS estimates that once the national bidding program is fully implemented, there will be 50 percent fewer suppliers doing business with Medicare than there are now.

That means the loss of thousands of companies and jobs for home care providers, and a loss of choice and access for the millions of patients they serve.

Which half will you be in? That’s hard to say even for the savviest experts. After wading through the massive rule and digesting the spotty information on the CBIC Web site, there simply aren’t enough answers.

Most agree, however, the scenario looks dire for small providers, particularly in the 10 competitive bidding areas targeted in the first round. After waiting on it for more than three years, they must not only master the rule but also figure out their bidding strategies against regional and national companies in only a matter of weeks. As of press time, CMS was expected to open its bid window any moment.

Even if you are tough and you do get going on preparation for this round or the next, you might not win your bid based on the government’s evaluation criteria. As well, you could be vying for one of only five contracts for a product category in any CBA, according to CMS’ competitive bidding math. And the really big gamble is, who can tell where reimbursement for the items included in the bid will end up?

Despite the circumstances, if you listen to hockey great Wayne Gretsky, you owe it to yourself to bid. After all, he advises, “you miss 100 percent of the shots you don’t take.”

Of course there are some alternatives. While network bidding is not as attractive as it was in the draft rule, there is that route for small providers. CMS has also opened the door to subcontracting and, if both you and your patients choose, there are grandfathering possibilities. You can certainly continue to do business in non-bid items, although there may not be many left after 2009’s second round when CMS will add to the number of products in its bid. Or, you can change your reimbursement-based model and go after a burgeoning retail audience.

But if none of those options appeal and you are truly at the end of your rope, then tie a knot and hang on. Those same savvy experts believe that for the companies left standing after the next few years, bidding will be less risky when contracts are recompeted (albeit because of the competitors who won’t be around).

The hard fact is no matter whether you decide to bid, or how, or if you win or lose, the future for your business, your employees and your patients will be vastly changed if it is dependent on Medicare. There may be only one thing that will stay the same if you come out on the other side of HME’s biggest challenge (last platitude, I promise): The only easy day was yesterday.