title: Impact of CMS Competitive Bidding Program on Medicare Beneficiary Safety and Access to Diabetes Testing Supplies: A Retrospective, Longitudinal Analysis.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: National Minority Quality Forum, Washington, DC.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Puckrein
authors.affiliation: Howard University Hospital, Washington, DC.
authors.forename: Gail
authors.initials: G
authors.lastname: Nunlee-Bland
authors.affiliation: George Washington University School of Medicine, Washington, DC.
authors.forename: Farhad
authors.initials: F
authors.lastname: Zangeneh
authors.affiliation: University of Texas, Southwestern Medical Center, Dallas, TX.
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Davidson
authors.affiliation: Walter Reed National Military Medical Center, Bethesda, MD Medtronic, Northridge, CA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Vigersky
authors.affiliation: National Minority Quality Forum, Washington, DC.
authors.forename: Liou
authors.initials: L
authors.lastname: Xu
authors.affiliation: CGParkin Communications, Boulder City, NV chris@cgparkin.org.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Parkin
authors.affiliation: Diabetes Translational Research Center, Indianapolis, IN.
authors.forename: David G
authors.initials: DG
authors.lastname: Marrero
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015190:Blood Glucose Self-Monitoring / Q000191:economics; D014487:Centers for Medicare and Medicaid Services, U.S.; D003164:Competitive Bidding; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007328:Insulin / Q000097:blood / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000191:economics*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
chemical_list: D007328:Insulin