Medicare’s Competitive Bidding Program

History

 

2011

January The Centers for Medicare and Medicaid Services (CMS) launches the Competitive Bidding Program in 9 test markets for diabetes testing supplies and other products, impacting mail order supplies. The original intent of Medicare’s bidding program was to reduce out-of-pocket expenses for fee-for-service Medicare beneficiaries and provide cost-savings to Medicare for certain durable medical equipment, including blood glucose meters and strips, while still ensuring beneficiary access to quality items and services.

Reimbursement for blood glucose testing supplies were approximate $14/vial of 50 strips.

November American Association of Diabetes Educators (AADE) issues first report on product availability, reporting that beneficiaries in the 9 test markets do not have access to most blood glucose meter brands available in the market, or to brands most commonly prescribed by physicians.  

 2012

April Despite reports, CMS reports that no disruption of access to diabetes testing supplies occurred and that no negative healthcare consequences to beneficiaries were seen as a result of implementation of the Competitive Bidding Program. Subsequent reports from CMS reiterated these findings.
May The Government Accountability Office (GAO) reports that the monitoring methods used by CMS in assessing the impact of competitive bidding could not determine whether beneficiaries received the durable medical equipment needed on time, or whether health outcomes were caused by problems accessing durable medical equipment (DME), thereby, calling the CMS findings into question.

 2013

July Despite reports and GAO findings, CMS launches the Competitive Bidding Program nationally, impacting both mail order and retail supply. Reimbursement was further reduced to $10.41/vial of 50 strips.

 2014

January AADE issues second report showing additional reduction in access. According to the report, Medicare’s bidding program is “limiting access to diabetes testing supplies. Limited availability of products from suppliers is compounded by inconstant and inaccurate information from Medicare and the suppliers, themselves.” The report went on to state: “If beneficiary access to the most appropriate or familiar monitoring systems is disrupted, patient compliance with monitoring regimens may decrease, and adverse complications may increase.”
February National Minority Quality Forum (NMQF) obtains data from CMS to assess the effects of the implementation of the Competitive Bidding Program on acquisition of diabetes testing supplies among Medicare beneficiaries with insulin-treated diabetes within the 9 test markets.
The study population was Medicare beneficiaries with a diagnosis of diabetes and a record of insulin treatment in 2009 (n=529,627).  This study population was separated into two groups, experimental and control, for analysis. The experimental group included all insulin-treated beneficiaries who resided in the nine piloted markets (TEST, n=43,939) in 2009. The control group included all non-test market insulin-treated beneficiaries (NON-TEST, n=485,688).
Among the types of insulin used, CMS records showed that 349,200 (65.9%) of beneficiaries were treated with short- or rapid-acting insulin (including pre-mixed insulins) with or without long-acting or NPH insulin; whereas, 180,427 (34.1%) were treated with long-acting or NPH insulin, only.
August American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) issue a commentary online in Roll Call titled: “Congress take note: 25 Million Diabetic Wonder Whose Minding the Diabetes Supply Store?” The commentary questions CMS’s ability to provide patient access high quality care and effective glucose monitoring yet still control program costs; if not, what changes need to be made?
September AACE/ACE Consensus Conference on Glucose Monitoring emphasized the potential impact of inaccurate blood glucose meters on outcomes in Medicare beneficiaries. Proceedings were published in 2015. In a subsequent letter to Congress, AACE/ACE stated: “Our current healthcare system is failing patients with diabetes in part due to issues of access, reimbursement and quality of glucose monitoring supplies.”

 2015

May NMQF presents its first poster at AACE meeting, showing a correlation between self-monitoring of blood glucose (SMBG) use and mortality in insulin-using diabetes patients.
June NMQF presents a second poster at ADA meeting, showing that access to diabetes testing supplies was disrupted in the 9 test market populations, leading to increased migration from full to partial/no SMBG acquisition with associated increases in mortality, inpatient admissions, and costs.
December NMQF issues a whitepaper (at the behest of the Senate Finance Committee staff), outlining the methodology flaws relevant to CMS’s reported claims of no disruption or adverse outcomes, including mortality and hospitalizations.   

 2016

January Full manuscript reporting findings from NMQF posters are accepted for publication in Diabetes Care.
March Diabetes Care article, showing increases in hospital costs and mortality associated with disruption in supplies available to Medicare beneficiaries with diabetes is published online.
AACE calls on Congress to suspend Medicare competitive bidding program for diabetes testing supplies.
National Diabetes Volunteer Leadership Council (NDVLC) sends letter to CMS urging immediate suspension of bidding program.