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Diabetes Care. 2016 Apr;39(4):563-71. doi: 10.2337/dc15-1264.

Impact of CMS Competitive Bidding Program on Medicare Beneficiary Safety and Access to Diabetes Testing Supplies: A Retrospective, Longitudinal Analysis.

Author information

1
National Minority Quality Forum, Washington, DC.
2
Howard University Hospital, Washington, DC.
3
George Washington University School of Medicine, Washington, DC.
4
University of Texas, Southwestern Medical Center, Dallas, TX.
5
Walter Reed National Military Medical Center, Bethesda, MD Medtronic, Northridge, CA.
6
CGParkin Communications, Boulder City, NV chris@cgparkin.org.
7
Diabetes Translational Research Center, Indianapolis, IN.

Abstract

OBJECTIVE:

In 2011, the Centers for Medicare & Medicaid Services (CMS) launched the Competitive Bidding Program (CBP) in nine markets for diabetes supplies. The intent was to lower costs to consumers. Medicare claims data (2009-2012) were used to confirm the CMS report (2012) that there were no disruptions in acquisition caused by CBP and no changes in health outcomes.

RESEARCH DESIGN AND METHODS:

The study population consisted of insulin users: 43,939 beneficiaries in the nine test markets (TEST) and 485,688 beneficiaries in the nontest markets (NONTEST). TEST and NONTEST were subdivided: those with full self-monitoring of blood glucose (SMBG) supply acquisition (full SMBG) according to prescription and those with partial/no acquisition (partial/no SMBG). Propensity score-matched analysis was performed to reduce selection bias. Outcomes were impact of partial/no SMBG acquisition on mortality, inpatient admissions, and inpatient costs.

RESULTS:

Survival was negatively associated with partial/no SMBG acquisition in both cohorts (P < 0.0001). Coterminous with CBP (2010-2011), there was a 23.0% (P < 0.0001) increase in partial/no SMBG acquisition in TEST vs. 1.7% (P = 0.0002) in NONTEST. Propensity score-matched analysis showed beneficiary migration from full to partial/no SMBG acquisition in 2011 (1,163 TEST vs. 605 NONTEST) was associated with more deaths within the TEST cohort (102 vs. 60), with higher inpatient hospital admissions and associated costs.

CONCLUSIONS:

SMBG supply acquisition was disrupted in the TEST population, leading to increased migration to partial/no SMBG acquisition with associated increases in mortality, inpatient admissions, and costs. Based on our findings, more effective monitoring protocols are needed to protect beneficiary safety.

PMID:
26993148
DOI:
10.2337/dc15-1264
[Indexed for MEDLINE]

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