Study: Medicare Competitive Bidding Program Could Impede Seniors' Access to Diabetes Testing Supplies
Coalition Aims to Support and Educate Seniors
WASHINGTON, June 18 /PRNewswire-USNewswire/ -- The new Medicare Durable Medical Equipment competitive bidding program that starts July 1 could make it more difficult for seniors to manage their diabetes care, according to a new analysis released today from The George Washington University School of Public Health and Health Services. "This analysis shows how the competitive bidding program makes an already vulnerable population even more vulnerable. Medicare must immediately take steps to help seniors with diabetes avoid confusion and ensure that their treatments are not interrupted," said Sara Rosenbaum, the lead author of the study and chair of George Washington University's Department of Health Policy. The analysis, sponsored by the Diabetes Access to Care Coalition (DACC), examined how Medicare's competitive bidding program for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) could impact how seniors manage their diabetes. The program is scheduled to begin July 1 in 10 metro areas: Charlotte, N.C.; Cincinnati, Cleveland; Dallas-Fort Worth, Tex.; Kansas City, Mo.; Miami, Riverside, Calif.; Orlando, Fla.; Pittsburgh, Pa. and San Juan, Puerto Rico. The competitive bidding program limits the number of mail order suppliers that Medicare beneficiaries in the metro areas can use to obtain their diabetes testing supplies. "This new Medicare program needs more protections for beneficiaries to ensure that they won't lose access to their diabetes management supplies. As diabetes educators, we know that access to supplies is critical for effective management of this disease. Any disruption in care for seniors with diabetes is simply unacceptable," said Donna Rice, RN, CDE and Past-President of the American Association of Diabetes Educators. The Coalition is concerned that competitive bidding for diabetic testing supplies may cause seniors to lose access to the most commonly prescribed diabetes testing supplies, or create confusion about where they can obtain the supplies they are currently using to help them manage their diabetes. The GWU study notes that in contrast to the standards in Medicare Part D and in Medicare Advantage, the competitive bidding program lacks rigorous standards for quality and safety, but instead is focused on price discounts. For example:
-- The only required contracting standards are that amounts paid to winning entities be expected to be "less than the (current fee schedule)" and that individuals have a "choice of multiple suppliers." There are no evidence-based standards for the types of products being offered.
-- The law setting up the program does require that winning contractors meet "applicable quality standards." CMS regulations do have quality standards for the program, but those standards lack specific marketing guidelines that would require approval of materials before entry into the marketplace, much like CMS imposes on Part D plans. Among the patient-focused standards CMS should insist suppliers meet ought to include materials that meet basic readability standards and toll-free telephone hotlines with Spanish-speaking options. The GWU study notes that CMS has not engaged in a major campaign to educate beneficiaries about the changes. "It is unclear how beneficiaries would learn to navigate the market to obtain daily products; indeed, it appears that they are simply expected to respond to aggressive marketing by online firms or through cold calls, precisely the type of aggressive marketing approaches that have raised concerns in other markets," the study says. The GWU study also noted that when Medicare conducted a demonstration program from 1999-2002 to study competitive bidding, diabetes equipment and supplies were not included. Therefore, CMS appears to have made no effort to obtain necessary data about how this program could affect the health of diabetes patients, but instead used the demonstration program to conduct a price comparison. In response to concerns from patients, the Diabetes Access to Care Coalition has been actively educating policymakers about the importance of diabetes self-management in the face of a diabetes epidemic. About 20 percent of Medicare's 43 million beneficiaries have diabetes, with an estimated 200,000 in the 10 areas where this program will be implemented. DACC members believe that an education program is critical to ensure that Seniors are not confused by the new program and led to believe that they must change how they manage their diabetes. The education program will make it clear that mail order is not their only option; they may choose to continue to receive their supplies from their community pharmacist. Some of the Coalition's members plan a toll-free call center to offer advice to Medicare beneficiaries with diabetes. Trained representatives will assist callers to locate the product they want and need, and also collect information from beneficiaries about their experiences in the competitive bidding program and share them with policymakers so they can promptly address any concerns with the implementation of the program. The hotline is one part of the coalition effort to help seniors with diabetes understand all their options under the new program, including purchasing directly from their local pharmacist, who provides personal care and consultation to ensure that beneficiaries have the right supplies for their needs. The DACC, comprised of patient advocates, caregivers, suppliers, and manufacturers of diabetes testing supplies, was formed in 2005 to address diabetes access issues relating to the Medicare Modernization Act (MMA) and the competitive bidding program.
SOURCE Diabetes Access to Care Coalition
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