OPINION:
The Centers for Medicare & Medicaid Services recently proposed a major expansion of the Medicare competitive bidding program to include urological, tracheostomy and ostomy supplies — items essential to the daily lives and dignity of millions of Americans.
If implemented, this policy change would be more than a bureaucratic adjustment. It would be a dangerous reversal of long-standing protections, putting vulnerable patients at risk, undermining innovation and potentially costing the health care system more than it saves.
During my tenure as U.S. surgeon general under President George W. Bush, I had the privilege of contributing to one of the most consequential reforms in our nation’s health care system: the Medicare Modernization Act of 2003. That bipartisan legislation introduced the first-ever prescription drug benefit under Medicare, but it also did something just as important: It drew a clear line around which medical products should and should not be subject to competitive bidding.
That line was drawn for good reason. Congress, working closely with clinicians and policy experts, explicitly excluded prosthetic supplies, such as urological, tracheostomy and ostomy products, from the Medicare competitive bidding program. These are not interchangeable widgets. They are highly specialized medical devices that restore lost bodily function and help patients lead independent, dignified lives.
More than two decades later, CMS is proposing to reverse course by bringing these same products under the bidding program. That is a dangerous mistake.
The underlying theory of competitive bidding in Medicare is sound when applied to generic, off-the-shelf equipment such as wheelchairs, walkers and oxygen tanks. For such products, price competition can drive down costs without substantially affecting quality, but the calculus changes when it comes to products that are inserted into the body or intimately involved in bodily functions.
These supplies are as variable as the patients who use them, including people living with ostomies after colorectal cancer, those with spinal cord injuries requiring catheterization and children born with congenital conditions that require lifelong use of tracheostomy tubes.
These patients depend on tailored devices, sometimes chosen after months of trial and error, to avoid skin breakdown, infection and hospitalization.
We have been down this road before. While I was surgeon general, the Department of Health and Human Services oversaw a pilot project in Polk County, Florida, in the early 2000s in which CMS included urological supplies in the bidding program.
The result? A dramatic reduction in supplier participation, shrinking product availability and real harm to patient care. The data was clear enough that in 2003, Congress specifically carved these products out of future competitive bidding entirely.
Yet here we are. The proposed rule would ignore that legislative intent and clinical wisdom, forcing these supplies back into a pricing model that incentivizes the cheapest, not the best. That model inevitably creates a “race to the bottom,” where innovation is stifled and patient needs are sidelined.
As a physician, I find this particularly troubling. In recent years, we have seen remarkable advances in ostomy and urological supplies, including improvements that reduce leaks, improve skin health and allow patients to resume active, fulfilling lives. These innovations don’t come cheaply, and they won’t continue if CMS creates an environment where the lowest bid determines what products are available to patients.
More important, this is a matter of patient safety. The Wound, Ostomy, and Continence Nurses Society has warned that a reduction in product availability could lead to higher rates of infection, more emergency room visits and worse outcomes for patients. That’s not speculation. It’s what happens when people are forced to use ill-fitting or inferior products because of restricted supplier networks.
I understand the pressure to control Medicare spending, particularly in the wake of fraudulent activity surrounding urinary catheters, but this is a penny-wise, pound-foolish policy. Any short-term savings realized by squeezing suppliers will be quickly offset by increased hospitalizations and medical complications.
Moreover, the administrative cost of reconfiguring a competitive bidding framework for products so inherently individualized will be substantial.
The Medicare Modernization Act wasn’t perfect, but it was deliberate. It recognized the unique status of certain medical supplies that cannot and should not be subject to pricing wars. CMS would do well to remember that history. There is still time to get this right.
CMS should withdraw this aspect of the proposed rule and preserve the long-standing protections for patients who rely on ostomy, tracheostomy and urological supplies. Their health, dignity and quality of life depend on it.
• Dr. Richard Carmona was the 17th surgeon general of the United States. He currently serves as a distinguished laureate professor at the University of Arizona.
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