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
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
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
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
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