AADE survey: Medicare competitive bidding system limits access, choice of diabetes test supplies

The latest round of Medicare’s Competitive Bidding Program for diabetes testing supplies reduced beneficiary choice and access to commonly used diabetes testing supplies, adversely affecting patient outcomes, according to a survey released by the American Association of Diabetes Educators.

“We’re still deeply concerned that the competitive bidding program is harming persons with diabetes by limiting their access to diabetes testing supplies, as prescribed by their treating providers,” Kurt Anderson, AADE Director of Federal and State Advocacy, told Endocrine Today. “It’s difficult to overstate how important self-monitoring is, especially if you’re beginning diabetes self-management training. You have to have consistency of supplies; you have to be familiar with the different devices that you have. Any break or rupture in that continuity is very difficult on patients.”

Kurt Anderson

Since the Centers for Medicare and Medicaid Services (CMS) implemented the competitive bidding program (CBP) for diabetes testing supplies purchased through mail-order suppliers in January 2011, several reports have noted that product choices are limited through the program, likely influencing patient health outcomes.

In an analysis by the National Minority Quality Forum released in March 2016, researchers assessing Medicare claims data from 2009 to 2012 found that the CBP disrupted beneficiaries’ ability to access diabetes testing equipment, leading to an increase in mortality, hospitalization rates and inpatient costs. In two “secret shopper” surveys in 2011 and 2013, AADE diabetes educators contacted contract suppliers authorized to sell diabetes testing supplies to Medicare beneficiaries through mail order. The participants found that CBP suppliers did not make available all products that were listed on the Medicare.gov Suppliers Directory. In addition, survey results revealed that many products available to beneficiaries before the implementation of round 1 of the program were no longer available through mail-order suppliers.

CMS is required to re-compete contracts under the CBP at least once every 3 years. Following the Round 2 re-compete in 2016, AADE conducted a third “secret shopper” survey with 11 national suppliers and found the following:

The number of brands of diabetes testing supplies carried by national mail order suppliers fell nearly 50% since the CBP began;
The number of diabetes test supply systems available under national mail-order is less than half the number available in 2009;
Many suppliers do not offer models covering 50% of the market share of diabetes test supplies; and
Suppliers do not provide consistent information about inventory to customers.
The most recent AADE survey, however, indicates improvements, with results suggesting fewer discrepancies between the information provided on Medicare.gov and what is available to consumers.

“The government has to be very sensitive in trying to provide a good benefit at a low cost,” Anderson said in an interview. “But at some point ... the money you don’t spend in trying to keep the program consistent is money you’re going to be paying down the line [in adverse outcomes].”

In February, CMS announced that it will temporarily delay moving forward with next steps of the Round 2019 CBP to allow the new administration an opportunity to review the program; CMS removed information that was posted to its website regarding the Round 2019 on Jan. 31. In a statement, AADE applauded that move, noting that the CBP should be overhauled to reflect evidence-based data and best practices.

“Evidence continues to show that the competitive bidding process is failing people with diabetes and putting them at unnecessary risk,” Kellie Antinori-Lent, MSN, RN, ACNS-BC, BC-ADM, CDE, a diabetes clinical nurse specialist at the University of Pittsburgh Medical Center, said in a press release. “Patient safety and choice must come first.”

Anderson said the program is a valuable one that can be repaired.

“But if it’s not going to work the right way, you’re really going to cause a lot of damage to people who desperately need these supplies and who desperately need consistency,” he said. – by Regina Schaffer

Reference: The AADE product availability survey can be accessed at: https://www.diabeteseducator.org/docs/default-source/advocacy/aade-study-on-suppliers-in-competitive-bidding-program_2016-(002).pdf?sfvrsn=2

Disclosures: Anderson is director of federal and state advocacy for AADE. The National Minority Quality Forum, a nonprofit organization, received support for the 2016 study from Abbott, Acelity LP Inc., Lifescan, Roche Diabetes Care, US Healthcare Supply LLC and US MED.