Impact of CMS competitive bidding program on medicare beneficiary safety and access to diabetes testing supplies

A retrospective, longitudinal analysis

Gary A. Puckrein, Gail Nunlee-Bland, Farhad Zangeneh, Jaime A. Davidson, Robert A. Vigersky, Liou Xu, Christopher G. Parkin, David Marrero

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

OBJECTIVE In 2011, the Centers for Medicare and 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 beneficiarymigration 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.

Original languageEnglish (US)
Pages (from-to)563-571
Number of pages9
JournalDiabetes Care
Volume39
Issue number4
DOIs
StatePublished - Apr 1 2016

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Competitive Bidding
Blood Glucose Self-Monitoring
Centers for Medicare and Medicaid Services (U.S.)
Medicare
Safety
Inpatients
Costs and Cost Analysis
Propensity Score
Mortality
Selection Bias
Population
Prescriptions

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Impact of CMS competitive bidding program on medicare beneficiary safety and access to diabetes testing supplies : A retrospective, longitudinal analysis. / Puckrein, Gary A.; Nunlee-Bland, Gail; Zangeneh, Farhad; Davidson, Jaime A.; Vigersky, Robert A.; Xu, Liou; Parkin, Christopher G.; Marrero, David.

In: Diabetes Care, Vol. 39, No. 4, 01.04.2016, p. 563-571.

Research output: Contribution to journalArticle

Puckrein, Gary A. ; Nunlee-Bland, Gail ; Zangeneh, Farhad ; Davidson, Jaime A. ; Vigersky, Robert A. ; Xu, Liou ; Parkin, Christopher G. ; Marrero, David. / Impact of CMS competitive bidding program on medicare beneficiary safety and access to diabetes testing supplies : A retrospective, longitudinal analysis. In: Diabetes Care. 2016 ; Vol. 39, No. 4. pp. 563-571.
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abstract = "OBJECTIVE In 2011, the Centers for Medicare and 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 beneficiarymigration 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.",
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T1 - Impact of CMS competitive bidding program on medicare beneficiary safety and access to diabetes testing supplies

T2 - A retrospective, longitudinal analysis

AU - Puckrein, Gary A.

AU - Nunlee-Bland, Gail

AU - Zangeneh, Farhad

AU - Davidson, Jaime A.

AU - Vigersky, Robert A.

AU - Xu, Liou

AU - Parkin, Christopher G.

AU - Marrero, David

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Y1 - 2016/4/1

N2 - OBJECTIVE In 2011, the Centers for Medicare and 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 beneficiarymigration 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.

AB - OBJECTIVE In 2011, the Centers for Medicare and 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 beneficiarymigration 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.

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