When I think of the industry’s efforts to battle CMS’s national competitive bidding program, I can’t help recalling that pivotal line from Shakespeare’s Henry V: “Once more unto the breach, dear friends.”

The young king stands before his troops during the Siege of Hafleur, urging his troops to muster enough will to attack the fortifications once more. The stakes are high — attacking a defended structure was brutal and bloody business in medieval warfare — but Henry can see that victory is in sight. The key is that his army is going to have to fight for it, and it’s not going to be easy. The only options are victory or defeat.

What better a metaphor for the HME industry’s battle with the well-defended bureaucracy that is CMS over competitive bidding?

There has been much back-and-forth in this battle since the industry was able to gain a delay in implementation of the program via the Medicare Improvements for Patients and Providers Act. The excitement over that delay came to an abrupt halt on the last day of the Bush Administration, when CMS implemented an interim rule that would restart bidding of round one of NCB. Then the Obama Administration, as one of its first acts, called on all federal agencies to delay any rules that were recently put in place in order to let the new administration conduct a policy review (this is common practice for incoming administrations).

It wasn’t until mid February that CMS moved to extend the effective date for from Feb. 17 to April 18. It kept its March 17 public comments deadline, however. (Turn to News, Trends & Analysis, page 8, to read more.)

Are these last minute rules and extensions an ill-intentioned game of chicken on the part of the CMS to wither the HME industry’s resolve? Possibly, but regardless of any cheap shots CMS might try to take, the HME industry simply sets its teeth, stretches its nostrils wide, holds hard its breath and bends up every spirit (to paraphrase good ole Will), and steps right into that breach to slug it out.

Such was the scene on Capitol Hill that preceded CMS’s extension. Providers and industry representatives from across the country flew into Washington as part of AAHomecare’s Feb. 11 Washington Fly-in to personally lobby members of Congress and their staff, and to speak at a congressional hearing called by Rep. Heath Shuler (D-N.C.), who chairs the House Small Business Subcommittee on Rural and Urban Entrepreneurship. There they let Congress know once more that competitive bidding, as well as the 36-month oxygen equipment rental cap, are policies that are bad for patients, bad for U.S. healthcare, and will force an industry consolidation that will eliminate thousands of jobs.

That’s a strong argument, especially in an economy such as ours. CMS has little that it can say in defense of its poorly considered and designed program in times such as these. And I can’t help thinking that when Rep. Shuler said during the hearings that CMS should “scrap the program and start over,” that the political will in Washington has clearly changed and that CMS is feeling intense pressure to alter its course. (Hence the extension.) I do believe the winds of this war have changed in favor of the HME industry.

But we’re not out of the dark, yet. The next industry gathering is Medtrade Spring, slated for March 24 to March 26 at the Las Vegas Convention Center. Check out our show preview starting on page 24 to learn more about which conferences and events at the show will help you arm yourself for the fight against competitive bidding.

Also, continue putting pressure on your local Representative and your Senators to force CMS to go back to the drawing table. The industry needs to maintain the intensity of its fight, and continue to take this battle to CMS’s home turf, stepping into that proverbial breech over and over again until the fight is finally won.