We knew the federal government's Medicare program was hurting people with diabetes by restricting access to necessary supplies, ever since the controversial competitive-bidding process kicked off in 2011. And we've been seeing anecdotal evidence of the negative effects trickling in ever since.
We just didn't expect it to be as bad as it really is, and now there's real scientific data to prove that.
This data is key to taking action as concern grows that the bidding program could expand to low-income populations on Medicaid and even beyond, to those covered by federal or state health exchanges, and eventually to those covered by private insurance.
The data in question came in the form of a late-breaking study at the big national ADA conference last month, showing that a disruption to D-supplies thanks to the CMS competitive-bidding program led to an increase in hospitalizations and complications for those using blood glucose supplies -- despite government claims that it would decrease costs overall and not have any dangerous impact. The National Minority Quality Forum conducted the study and looked at data from 2009 to 2012, including 778,000 people and finding that 23% of PWDs had received less than what they required for proper D-management.
That study also showed that deaths appeared to be almost twice as high in areas using the competitive-bidding program compared to places not, and that in competitive bidding regions nearly 1,000 beneficiaries were admitted to the hospital at a cost of $10.7 million (!) compared to only 460 people costing $4.7 million in non-bidding areas of the country.
The researchers say the methodology used was the same as past Surgeon General studies on smoking dangers, in that it eliminated variables that might confound whether smoking (or CMS competitive bidding, in this case) causes health problems and death.
"Based on our findings, our original hypothesis regarding the potential benefits of the program was incorrect (emphasis added by us) and it is quite clear that access to diabetes testing supplies was somehow disrupted in the test markets," said study author Dr. Jaime Davidson 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."
We've heard this before, as the AADE (American Association of Diabetes Educators)
and other groups have also looked into the issue. But it seems the more
data we accumulate, the worse the picture appears to be...
"Congress still believes CMS, that there has been no harm, and wants to extend the outcome to Medicaid patients..." says Bruce Taylor, director of government strategy and relations at Roche Diagnostics who is also living with T1D. "Congress continues to say. 'I haven't heard from any constituents,' so that right there is where we need to sound the alarm bells."
Taylor tells us that at the recent diabetes conferences where this data was presented, the number of endos who looked at the research posters and said, "Thank you for doing this study, because it shows my intution was correct," was astounding. Many doctors have expressed frustration with competitive bidding, because they feel they waste time and energy getting Medicare PWDs on a diabetes management routine, only to have bidding changes undermine their efforts and basically require them to start over with patients.
Now with a strong arsenal of data -- this latest research, plus the two AADE studies showing the CMS program's impact, and even internal CMS data showing that parts of the country where competitive bidding is in full swing (like Pittsburgh, PA) have significantly higher rates of mortality than others, it's time for the policy-makers to start taking notice!
This past Friday, Roche Diabetes Care -- which has been championing this issue for several years now -- gathered a group of Diabetes Online Community (DOC) advocates for a conference call to review the latest data and discuss how to move forward. Taylor told the group that the Diabetes Congressional Caucus members have received copies of the new research and background information for review. Next up: publishing the full manuscript of that research for peer review.
But really, he says, it comes down to us in the D-Community speaking out. We need to raise our collective voice, or the situation could get even worse.
Time to Take a Stand
Using the latest research findings as ammunition, the newly formed patient advocacy group DPAC (Diabetes Patient Advocacy Coaltion), led by D-Advocates Christel Aprigliano and Bennet Dunlap, has created an action plan aimed at making Congress aware of this issue and asking lawmakers to hold a hearing about this. As DPAC describes it, we should collectively "ask Congress to find the truth" about Medicare test strip bidding.
From their web site:
"We don't know the truth about Medicare's diabetes supply program. Medicare says their bidding program has not impacted access or patient safety (but) research presented at the ADA Scientific Sessions shows that people with diabetes faced higher risks of death and hospitalization. Congress should find the truth!"
This is smart thinking about an important issue!
So does this apply to you?
If you're on Medicare, no doubt it does. If you're close to Medicare age, it's a pressing concern that's right around the corner.
But even if you're in your 20s or 30s or early 40s, far off from being dependent on Medicare, this is still KEY to your health with diabetes because the reality is that What Medicare Does, Other Insurers Follow. It's only a matter of time before the rest of those offering health insurance will follow suit and start cracking down on access to supplies (much like we've seen time and time again in different states and local communities).
The topic will be discussed at the upcoming MasterLab diabetes advocacy forum held in conjunction with the Children With Diabetes Friends For Life conference in Orlando, FL, as well as during an event event during the final day of that FFL conference. CWD leader Jeff Hitchcock says military families on Tri-Care also need to be aware of this issue, as the same program could be applied for that insurance coverage.
"The dominoes are lining up," says DPAC co-founder Bennet Dunlap, pointing out that it's only a matter of time before this CMS bidding logic may be applied to insulin pumps and other diabetes technologies. "We need to watch that, because they'll... say all pumps are the same, and that personal choice isn't important."
Here's how you can help:
1. Share your story. Try it this way, maybe.
2. Tell your lawmakers in Congress. This is very simple, thanks to DPAC's efforts.
3. Spread word to others about this issue, via Twitter, Facebook, word-of-mouth, whatever works for you.
So go on, please raise your voice and let's make a difference in getting Congressional attention on this very important issue -- before more damage is done that may be irreparable.