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CMS competitive bidding program: Reducing healthcare cost through subtraction of care


WHAT IT MEANS AND WHY IT'S IMPORTANT — It's counterintuitive. The durable medical equipment competitive bidding program is supposed to reduce the cost of care, but in fact — across many rural communities — it may end up serving as a barrier to the access of that care. Though truth be told, in the end it will succeed in reducing the overall cost of care in much the same way the cost of sugarcane would be reduced in a sugar-free zone. If you can't access the care, you can't pay for it and, consequently, the cost of that care is less expensive. How's that for backward math?

(THE NEWS: Louisiana pharmacist to Congress: Independents need to stay in the DME business. For the full story, click here

Impeding access to durable medical equipment impacts the quality of care accessible to diabetics. This is especially important for those living on the outskirts of "The Big Easy" — statistically speaking, 10.3% of Louisiana residents have been diagnosed with diabetes, versus a national average of 8.3%. For some in the "Bayou Country," that would mean increasing a possible five-mile trek to upwards of 50 miles, Louisiana pharmacist Randy Mire testified. And with the cost of gas right now eclipsing $4 per gallon in the New Orleans area, that's an additional cost burden for Louisiana's rural diabetics.

But the impact of not exempting community pharmacies from the DME competitive bidding program will extend well beyond the state. "By 2016, all DME suppliers, mail order and retail, will be subject to competitive bidding or competitive bidding pricing for [diabetes testing supplies]," noted the National Community Pharmacists Association in written testimony to Congress. "In addition, unfortunately, in the context of the national mail order [competitive bidding program], CMS is prohibiting retail pharmacies from providing home delivered [diabetes testing supplies] unless such a pharmacy wins a national mail-order [competitive bidding program] contract."

If that drives 92% of independents out of the diabetes business, as NCPA's poll suggests, that will be one bitter pill for rural diabetics across the country to swallow, and all without a bit of sweetener in sight. Well, at least not for 50 country miles.

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