TY - JOUR
T1 - Impact of the 2013 national rollout of CMS competitive bidding program
T2 - The disruption continues
AU - Puckrein, Gary A.
AU - Hirsch, Irl B.
AU - Parkin, Christopher G.
AU - Taylor, Bruce T.
AU - Xu, Liou
AU - Marrero, David G.
N1 - Funding Information:
Funding. The National Minority Quality Forum, a nonprofit organization, received support for the studyfromAbbottDiabetesCare,Acelity,LifeScan, Inc. (part of Johnson & Johnson Diabetes Solutions Companies), Roche Diabetes Care, US Healthcare Supply LLC, and US MED. I.B.H. receives research grant support from Novo Nordisk and Sanofi. Duality of Interest. I.B.H. serves as an advisory board member for Abbott Diabetes Care, Roche, and Becton Dickinson. C.G.P. is an employee of CGParkin Communications and has received consulting fees from Animas Corporation, CeQur SA, Dexcom, Inc., Insulet Corporation, Roche Diabetes Care, Senseonics, and Sanofi. B.T.T. is an employee of Blackbriar LLC. No other potential conflicts of interest relevant to this article were reported. Author Contributions. G.A.P. and L.X. developed the study protocol, provided statistical analysis, and contributed to data interpretation. I.B.H., C.G.P., B.T.T., and D.G.M. contributed to data interpretation and wrote the manuscript. All authors reviewed the manuscript and accept responsibility for the contents of this report. G.A.P. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Prior Presentation.Portionsofthestudy findings were presented as a late-breaking poster at the 77th Scientific Sessions of the American Diabetes Association, San Diego, CA, 9–12 June 2017.
Publisher Copyright:
© 2017 by the American Diabetes Association.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - OBJECTIVE: Use of glucose monitoring is essentialtothe safety ofindividuals with insulin-treated diabetes. In 2011, the Centers for Medicare and Medicaid Services (CMS) implemented the Medicare Competitive Bidding Program (CBP) in nine test markets. This resulted in a substantial disruption of beneficiary access to self-monitoring of blood glucose (SMBG) supplies and significant increases in the percentage of beneficiaries with either reduced or no acquisition of supplies. These reductions were significantly associated with increased mortality, hospitalizations, and costs. The CBP was implemented nationally in July 2013. We evaluated the impact ofthis rollout to determine if the adverse outcomes seen in 2011 persisted. RESEARCH DESIGN AND METHODS: This longitudinal study followed 529,627 insulin-treated beneficiaries from 2009 through 2013 to assess changes in beneficiary acquisition of testing supplies in the initial nine test markets (TEST, n = 43,939) and beneficiaries not affected bythe 2011 rollout (NONTEST, n = 485,688). All Medicare beneficiary records for analysis were obtained from CMS. RESULTS: The percentages of beneficiaries with partial/no SMBG acquisition were significantly higher in both the TEST (37.4%) and NONTEST (37.6%) groups after the first 6 months of the national CBP rollout, showing increasesof 48.1% and 60.0%, respectively (both P < 0.0001). The percentage of beneficiaries with no record for SMBG acquisition increased from 54.1% in January 2013 to 62.5% by December 2013. CONCLUSIONS: Disruption of beneficiary access to their prescribed SMBG supplies has persisted and worsened. Diabetes testing supplies should be excluded from the CBP until transparent, science-based methodologies for safety monitoring are adopted and implemented.
AB - OBJECTIVE: Use of glucose monitoring is essentialtothe safety ofindividuals with insulin-treated diabetes. In 2011, the Centers for Medicare and Medicaid Services (CMS) implemented the Medicare Competitive Bidding Program (CBP) in nine test markets. This resulted in a substantial disruption of beneficiary access to self-monitoring of blood glucose (SMBG) supplies and significant increases in the percentage of beneficiaries with either reduced or no acquisition of supplies. These reductions were significantly associated with increased mortality, hospitalizations, and costs. The CBP was implemented nationally in July 2013. We evaluated the impact ofthis rollout to determine if the adverse outcomes seen in 2011 persisted. RESEARCH DESIGN AND METHODS: This longitudinal study followed 529,627 insulin-treated beneficiaries from 2009 through 2013 to assess changes in beneficiary acquisition of testing supplies in the initial nine test markets (TEST, n = 43,939) and beneficiaries not affected bythe 2011 rollout (NONTEST, n = 485,688). All Medicare beneficiary records for analysis were obtained from CMS. RESULTS: The percentages of beneficiaries with partial/no SMBG acquisition were significantly higher in both the TEST (37.4%) and NONTEST (37.6%) groups after the first 6 months of the national CBP rollout, showing increasesof 48.1% and 60.0%, respectively (both P < 0.0001). The percentage of beneficiaries with no record for SMBG acquisition increased from 54.1% in January 2013 to 62.5% by December 2013. CONCLUSIONS: Disruption of beneficiary access to their prescribed SMBG supplies has persisted and worsened. Diabetes testing supplies should be excluded from the CBP until transparent, science-based methodologies for safety monitoring are adopted and implemented.
UR - http://www.scopus.com/inward/record.url?scp=85046119939&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046119939&partnerID=8YFLogxK
U2 - 10.2337/dc17-0960/-/DC1
DO - 10.2337/dc17-0960/-/DC1
M3 - Article
C2 - 29150529
AN - SCOPUS:85046119939
SN - 1935-5548
VL - 41
SP - 949
EP - 955
JO - Diabetes Care
JF - Diabetes Care
IS - 5
ER -