OPINION:
For the many Medicare patients who rely on ostomy and urological supplies, January 2028 could bring an unwelcome change to their daily care. The supplier they know and trust may no longer be able to provide the products they depend on.
The Centers for Medicare & Medicaid Services is preparing to expand its Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program in 2028 to include urological and ostomy supplies.
Under the new system, Medicare will pay contracted suppliers to provide essential medical devices to patients — a change that involves far more than who ships a box to a patient’s door.
For patients, a change in supplier can mean a change in the specific device critical to their well-being. The wrong product can have serious consequences for a patient’s health, independence and dignity, and ultimately generate additional costs for patients and taxpayers.
As a physician and former acting surgeon general, I have seen firsthand how even seemingly small disruptions to patient care can lead to serious health complications, additional treatment and hospitalizations. That is why CMS’s decision deserves careful scrutiny.
Controlling unnecessary healthcare costs is a legitimate and important objective. However, for patients who rely every day on highly individualized medical supplies such as catheters or ostomy pouches, this approach will carry significant physical, psychological and financial consequences.
Quality, choice and access are important, as is cost control, but we need to balance these criteria and not race to the bottom in the interest of economics. These supplies are critical not only for their physical purposes but also for improving the quality and dignity of life for so many patients.
Product selection for ostomy and urological care is a highly personal clinical decision made between a care provider and the patient. Selecting the appropriate medical product depends on factors including diagnosis, anatomy, skin condition, mobility and other individual daily needs.
These considerations make product selection an integral part of clinical care rather than simply a purchasing decision.
Past efforts to include urological supplies in competitive bidding illustrate why CMS should proceed cautiously. In its evaluation of the Polk County demonstration, CMS found that urological supplies generated substantially smaller savings than many other categories, attracted relatively few bidders and raised concerns about whether there was sufficient competition to make bidding effective.
The report also raised concerns over reduced patient access to preferred urological products and brands. For good reason, these concerns led to the exclusion of individualized products, such as urological supplies, from subsequent rounds of bidding.
These products are not optional consumer goods; they are medical supplies that support vital bodily functions and enable millions of Americans to live safely and independently. Patients should not bear the consequences of repeating a policy that could significantly compromise access to crucial products.
The consequences of this extend well beyond patient discomfort, as an ill-fitting catheter can cause pain, trauma and infection. An improperly sized ostomy pouch and wafer can cause waste leakage, leading to skin breakdown and infections that require additional treatment.
Over time, these complications exact a price, creating a significant financial burden for the government, as the costs of additional physician visits, treatments and hospitalizations can erode the initial savings achieved from purchasing lower-priced devices.
At a time when families across the country are already facing high healthcare costs, CMS should avoid implementing a system that could make entirely preventable medical complications and hospitalizations more likely.
We should not reduce healthcare costs by asking patients to compromise on the products their health depends on. It is not too late for CMS to reconsider its approach.
Before the program takes effect, CMS should exclude urological and ostomy supplies from competitive bidding and work with patients, clinicians and medical professionals to establish a process that preserves access to these products while reducing government spending.
CMS has a responsibility to administer Medicare to the American people. It also has a responsibility to ensure that beneficiaries receive appropriate, high-quality care. If implemented strategically, competitive bidding can achieve these goals and benefit Medicare, taxpayers and, most important, patients.
CMS should not pursue this approach at the expense of access and quality, professional and individual choice and personal dignity and quality of life.
• Dr. Kenneth Moritsugu served as deputy surgeon general of the United States from 1998 to 2007 and as acting surgeon general in 2002 and from 2006 to 2007.
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