An Analysis of the CMS Competitive Bidding Program

Causing more harm than good for patients…

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A disruption in access to diabetes supplies due to the competitive bidding program led to an increase in hospitalizations and complications for beneficiaries that use self-monitoring blood glucose (SMBG) supplies.

On June 7th the analysis of CMS’s bidding program was presented at ADA’s 75th Scientific Sessions. Following implementation of the program in nine pilot markets and reports that it would decrease out-of-pocket costs for beneficiaries and increase Medicare savings for SMBG supplies without disrupting access, the program went nationwide. This meant that in 2013 all Medicare beneficiaries became enrolled in the program.

The National Minority Quality Forum conducted a study to determine if CMS’s conclusions about the program were accurate and how it affected access to supplies for diabetes patients. Their conclusions were far different. Researchers used a propensity score to assess CMS data from 2009-2012.

They found that some beneficiaries in the nine pilot markets had not received all of the SMBG supplies they needed. The analysis showed that 23% of patients had received less than what was required for proper monitoring while in non-test markets that was far less at 1.7%.

In the propensity score matched analysis, the number of deaths was almost double in the test markets at 102 versus 60 in non-test markets. When comparing hospital admission rates, roughly 1,000 beneficiaries in test markets were admitted while 460 in non-test markets were admitted to the hospital. The difference in cost was $6 million in the test markets.

“Based on our findings, our original hypothesis regarding the potential benefits of the program was incorrect and it is quite clear that access to diabetes testing supplies was somehow disrupted in the test markets,” said Dr. Jaime Davidson, study author and Professor of Medicine at the University of Southwestern Medical Center. “For people with diabetes, especially those older adults in the Medicare population, consistent access to a quality glucose meter, sterile finger lancets and enough test strips is absolutely critical to managing their disease, and this study shows that this disruption in access to life-saving medical supplies has been detrimental to patient care.”

Practice Pearls:

• CMS’s competitive bidding program has led to increased hospital admissions and a decrease in patient access to critical supplies.
• CMS implemented their program in nine pilot markets and concluded positive results following its initiation.
• Further analysis into this program indicates this was far from beneficial for beneficiaries.

“Disruption in Access to Diabetes Monitoring Supplies Leads to Increased Hospitalizations, Mortality Among Medicare Beneficiaries.” a late-breaking study (abstract 139-LB) presented Sunday, June 7, at the American Diabetes Association’s 75th Scientific Sessions.