Evidence keeps mounting that the Centers for Medicare and Medicaid Services (CMS) competitive bidding program for diabetes supplies is doing more harm than good -- preventing people with diabetes from getting the test strips and supplies they need to stay healthy without actually saving any money.
A new peer-reviewed study being published in the April edition of the American Diabetes Association's highly-respected Diabetes Care journal shows that the competitive bidding program is putting Medicare beneficiaries' lives at risk.
What's most significant about this new study is that it's peer-reviewed and published in a highly-regarded diabetes medical journal, and it's exactly the kind of data that Medicare has said it would need in order to change the competitive bidding system. This retrospective, longitudinal analysis by the National Minority Quality Review Forum found that the changes are in fact endangering lives and hurting people -- especially females, the elderly, and African American populations.
Despite what CMS claims.
This competitive bidding program initially launched in 2011 in nine areas of the country and has been expanded in a phased approach since then, leading up to another expansion that went into effect on July 1, 2016. It requires PWDs (people with diabetes) on Medicare to use specific types of meters and supplies made by those suppliers who submit low bids and get the federal government's OK. They must order mail-order, and often the CMS-sanctioned meters are cheaper, lower-quality products that the FDA has already questioned as to accuracy. Just over a year ago, CMS added insulin pumps into the competitive bidding mix and data shows that access is being limited on those D-devices, too.
Lives Don't Matter to CMS?
The fact is that many PWDs are confused about how to get their diabetes equipment. They are ending up with fewer supplies, and as a result are testing their glucose less often. They are not able to get access to, or continue using, many diabetes devices they'd been using in the past before this CMS program. Some people are ending up in the hospital. Frighteningly, the new data shows that PWDs in competitive bidding regions are actually dying more frequently than areas not impacted by this rule.
Yet, CMS doesn't seem to care.
The data just released follows up on data released in 2015, research by the AADE (American Association of Diabetes Educators) in late 2014, and even some data pre-dating that. It all echos the concerns that many have brought up since the start of this program, even before it went into effect.
original intent of the Competitive Bidding Program was to save money on
durable medical equipment, but the data shows it is actually driving up
costs in the form of avoidable hospital bills and exposing
beneficiaries to much higher out-of-pocket costs for those unnecessary
inpatient stays," according to a press release on the new study.
Still, CMS doesn't care. Or at least they're not responding.
At the end of March, following the recent Diabetes Care journal publication, two big diabetes organizations -- the American Association of Clinical Endos (AACE) and National Diabetes Volunteer Leadership Council (NDVLC) -- have urged CMS to suspend the competitive bidding program. They're also advocating to Congress (specifically the Senate Finance Committee) to do the same and put more oversights in place.
But so far, CMS doesn't seem to be listening.
Ironically, this comes at the same time CMS is expanding the Diabetes Prevention Program and putting more attention on prediabetes. A plan announced on March 23 will have Medicare paying for certain "lifestyle change programs" for counselors to help patients eat better and be more active to offset new cases of type 2. So while CMS is interested in preventing diabetes, they apparently have little interest in helping those of us whose pancreases are already broken and are in need of life-saving supplies, including access to Continuous Glucose Monitors, to better manage our chronic health condition.
Frankly, we're outraged about this, especially seeing CMS's ridiculous clamoring about how successful this competitive bidding program is despite all the proof to the contrary.
The message is abundantly clear: CMS cares more about money than people's health.
That's not a tagline btw, but a tragic truth at the moment.
'The Flint Water Crisis of Diabetes'
If you don't think so, I invite you to consider the analogy of the Flint Water Crisis in Michigan.
This tragedy is close-to-home for me, as it's happening in a Southeast Michigan community just about 30 miles north of where I live. The basics: Flint was in dire financial circumstances and a state emergency manager was put in charge, In roughly 2013, this governor-appointee decided it would help save money to disconnect Flint from the regional Detroit Water system and instead use local water. They turned to the Flint River, which anyone in this area knows has been polluted and contaminated from rust and lead pipes for decades. Yet, money won the argument.
Doctors and researchers saw problems immediately and made many public statements about the water being toxic, but the state's Department of Environmental Quality kept reassuring people it was OK to drink. The state government essentially ignored the situation, and pretty much told people to 'stop griping about the water.' Yet, lead contamination and Legionnaire's Disease began appearing, and eventually the amount of damage couldn't be contained.
The Flint story has now become a well-known national tragedy of scandalous proportions that has led to people being fired, emergency managers shipping in water to Flint, and the Michigan governor now facing calls to resign from even a Congressional task force.
There was ample evidence that the water was toxic and people were being hurt, but officials just didn't listen. Or they didn't care. Until it got REALLY ugly.
One might say the same thing is happening with CMS and this competitive-bidding program.
Honestly, what has to happen before CMS takes action? How bad do the negative outcomes have to get before they acknowledge the cost in human life?
Apparently, the data alone isn't going to convince CMS.
Advocate for Change!
We need to take these pleas to Congress and our elected leaders, working with the doctors and organizations already advocating on this front. I'd suggest tacking the #FlintWaterCrisis example to our advocacy messages, to make it clear what kind of public health danger we're talking about.
In a recent advocacy webinar hosted by the Diabetes Patient Advocacy Coalition (DPAC), we heard the JDRF's policy expert say that this CMS focus on prediabetes is a slightly different animal that fits into a very big and complex Medicare system. But at the very least, it's a good sign that CMS has diabetes on its radar. That might make future D-advocacy on competitive-bidding, CGM access, and other issues more appealing for the agency's consideration, she said.
We are happy DPAC is already on the case, with an initiative called #SuspendBidding and a ready-made online petition we can all sign to show our support. You just type in your name and address, and the system shoots off a message to Congress on your behalf.
Make sure to check out the Suspend Bidding Action Center, which has some great infographics and resources to use in your own advocacy.
It's a start, and one that we believe the whole Diabetes Community needs to get behind -- whether we're type 1 or type 2, currently on Medicare, approaching that age, or not.
If the evidence shows something is wrong and those in charge still won't listen, clearly it's time for a grassroots effort to get LOUD about this problem before the damage escalates even more.