There has been much conversation about the challenges associated with competitive bidding. From gaining accreditation to submitting a bid, suppliers are scrambling to accomplish multiple objectives, all for the purpose of servicing a demographic, which—in the diabetes business at least—represents the largest majority in need of the products out to bid.

Diabetes is different from many other conditions because of the chronic nature of the disease, the number of people affected, and the important role that self-care plays in limiting downstream complications. Data clearly shows that better adherence to self-monitoring of blood glucose levels significantly improves quality of life, and decreases complications related to diabetes.

Most people know the Medicare Reform Act as the prescription drug benefit bill. What most of the general public does not know is that bundled into that bill are other reform measures. These measures have put pressure on organizations to strengthen and improve their business practices, and to force cost containment into the home medical market. While these are certainly worthwhile endeavors that seem to be working in concert with one another, when you get down into the details of these two things, the symbiosis is far less apparent.

Take accreditation, for example. CMS requires that all those who provide Medicare beneficiaries with products and services to become accredited by a recognized agency.

In general, accreditation principles are wonderfully sound practices for all businesses to embrace to ensure their continued success and vitality. Having been through the process of accreditation and renewal of accreditation several times, it is Neighborhood Diabetes' opinion that the road to success is absolutely guided by these beliefs. However, looking at the rigorous process of submitting an organization for the competitive bidding program, it seems to guide one away from some accreditation principles that call for consumer-oriented philosophy and high-quality services and products. In fact, the processes force organizations to reconsider service features and product selections for this demographic.

Our concerns with competitive bidding on diabetes supplies are centered on both economics and patient care issues. It is the belief of Neighborhood Diabetes that Medicare will not save money in the long run by bidding out diabetes testing supplies. The ripple of short-term cost savings from the program will be dwarfed by the tidal wave of costs that will come from diabetes complications. These complications could be suffered by Medicare participants who are not trained sufficiently, or who have other individual issues that leave them unable to adhere to their recommended treatment regimen.

Kathleen Belmonte

Sufficient training includes meter usage education and reinforcement, live call centers for customer service support, and product selection from equipment that fits the individual's cognitive, visual, and manual dexterity needs. While outside lawmakers may feel that the technology associated with managing this disease is not overly complex, diabetes management is about more than just getting the machines to work.

When manufacturers design new products and product upgrades, whether on the glucose meter or insulin pump front, they seek input and guidance from physicians and clients about what their needs are with the treatment and management of this disease. If you look at the technology that has been emerging in the diabetes marketplace over the last 5 years, you see that the focus has shifted from measurement-based to management-based.

As physicians and insurance companies look at HEDIS measures and A1c scores as indicators of success, patients are being asked to more actively participate in the treatment of their condition. This typically involves lifestyle changes that require a great deal of emotional and educational support.

Studies have shown that those individuals with diabetes who are able to understand and apply the concepts of diabetes management have better results in reducing complications often associated with this disease. They are already at risk for a greater number of costly and chronic health conditions. Removing support and product features will merely bring greater costs into the health care system as a whole when you then treat those beneficiaries for costly conditions such as end-stage renal disease, amputations, heart disease, hypertension, neuropathy, retinopathy, and other conditions. While there may be a tightening of expenses on the front end of this disease treatment, there will be a balloon effect on the back end with increasing emergency department visits and nursing home needs.

In the current reimbursement environment, Medicare suppliers of diabetes testing equipment, such as Neighborhood Diabetes, compete for clients based on the level of service they provide rather than price—which has historically been set by Medicare in a DME fee schedule. Overall, this leads to better-educated patients who receive information and training from their suppliers—information that supplements the often hurried explanations received from sometimes overwhelmed clinicians who face continuously declining reimbursable time with their patients.

Jennifer Delphia

At Neighborhood Diabetes, we receive calls and letters from clients and family members of clients who thank us for taking the extra time. In one case, we received a letter from a woman client who had just lost her husband. She wrote to us to tell us how, before he died, he told her that he felt safe leaving her because he knew we would be there to take great care of her. She thanked us and let us know what tremendous faith they both had in our organization. Moments like these make us proud and even more determined to continue to do everything possible to advocate for our clients.

As we've discussed, seniors often have difficulty with dexterity, vision, hearing, and other complications associated with aging. DME suppliers that have had to submit a competitive bid will have an incentive to provide the lowest cost product in the most efficient possible manner—regardless of that item's appropriateness. Neighborhood Diabetes believes this will "leave behind" Medicare participants who need the type of support or special products we routinely provide to Medicare recipients.

The removal of funding will impact the ability to interact with clients on a more personal level and truly guide them toward better health outcomes. Having potentially low-cost providers offering generic glucose testing equipment and little training or support to patients would actually lead to higher long-term costs for the Medicare program. n

Kathleen Belmonte, MS, RN-CS, CDE, is vice president of clinical services for Neighborhood Diabetes, Wakefield, Mass, and Hampton, NH. She can be reached via e-mail: .
Jennifer Delphia, MBA, is vice president of client services for Neighborhood Diabetes, Wakefield, Mass.