With health care reform, Congress is prepping to reshape roughly one-sixth of the economy. When a final health care bill emerges, it will almost certainly run hundreds of pages and could dictate the fortunes of everyone from hospitals to software companies.

Big pharmaceutical and insurance companies have poured millions of dollars into lobbying over the broad strokes of the legislation. But even the details will send shocks through smaller players across the country, and they’re spending money on K Street, too.

“I think there are very few organizations out there, and clients, that are only focused on the big picture,” said Michael Gaba, a partner in the Washington office of Holland & Knight who leads the firm’s health lobbying. “There are plenty of smaller players that really do have very particular interests.”

Lobbyists say many new clients are hoping to win business either from the health reform legislation itself or through the billions set aside for health information technology and comparative effectiveness testing under the stimulus bill. One coalition wants software made by its member companies to be used to determine whether doctors are appropriately ordering medical imaging tests. Others want specialized rehabilitative equipment to be covered or Medicare reimbursement codes to be changed.

Companies’ interest can be measured in part by the sheer volume of lobby registrations pointed at health issues. So far this year, the nonprofit Center for Responsive Politics reports 1,476 clients lobbying on health issues in the first quarter, on track to surpass the 1,890 clients who lobbied on health issues during all of 2008. Clients who lobby on health issues reported spending considerably more on lobbying in the first quarter of 2009 — $256.7 million — than the $225 million spent by clients lobbying on health issues in the first quarter of 2008, according to the center. And those totals don’t necessarily include companies that reported lobbying on related issues, such as Medicare, that will also be affected by health care reform.

Nicholas Allard, head of the public policy group at Patton Boggs, said the Washington-based firm’s health practice group has signed up new clients every day for the past month. They include APS Healthcare Inc., a health care management company in White Plains, Md., that had no lobby registrations listed before Patton Boggs’ filing in April.

Allard said there are two kinds of new clients “that aren’t the usual suspects.” The first want to monitor the legislation and receive an analysis of how it might affect them. The second, he said, are “individual companies, hospitals, professional groups, who are very, very focused on a narrow provision and maybe want to lobby.”

‘TAKE A DEEP BREATH’

Washington lobbying firms say they were expecting the rush and have been hiring with health care reform in mind.

Van Scoyoc Associates brought on Edward Long in January. Long, a one-time staffer for Sen. Tom Harkin (D-Iowa), among others, was formerly at Capitol Associates. Long said he’s been getting inquiries from corporations and consultants who want to keep track of what’s going on generally. He’s also received what he described as “a number of inquiries” from companies that specifically want to tap into the health information technology funding or are worried about coming out on the wrong side of the reform bill.

“Some people are going to lose in this picture, or some people are going to get taxed, or certain providers are going to get squeezed,” Long said.

Gaba, the Holland & Knight partner, said the firm has hired seven new people so far this year to lobby on health issues. The new hires brought clients such as Siemens Medical Solutions USA Inc., which lobbies on health information technology, among other things, and the National Hemophilia Foundation.

Gaba himself represents the E-Ordering Coalition, a group of four companies that banded together with the Center of Diagnostic Imaging and the American College of Radiology earlier this year to push software as an alternative to what are referred to as radiology benefit managers. The coalition wants its software, rather than human managers, to evaluate the use of medical imaging tests when doctors order them for patients. The coalition paid Holland & Knight $30,000 in the first quarter of 2009, lobbying disclosure reports show.

Not everyone thinks it’s time to lobby on the details. Stephanie Silverman of Venn Strategies, a firm with a large health care practice, said she is “trying to encourage our clients to take a deep breath.

“There are a lot of companies now who are saying how can we try and get a piece of the action,” she said. Silverman is encouraging such clients to start building alliances with other organizations that have similar interests so that, when policymakers are ready to discuss their issues, they’re well positioned to be heard. One example of a client she said has done that well: the Campaign to End Obesity, which has steadily built public support for its goals and holds workshops to educate congressional staff.

And Linda Tarplin, a health care specialist at Tarplin, Downs & Young, said those who want to have a voice in health care reform need to move fast, if they haven’t already. “We’re trying to do so much in such a short amount of time,” Tarplin said, “that, arguably, if you’re not up and running and you haven’t been involved in this debate for the past six months to a year, seeing health care coming down the tracks, where have you been?”

Carrie Levine may be contacted at carrie.-levine@incisivemedia.com.