LUGPA Policy Brief:
Opposition to Expanding the Competitive Bidding Program to Urological, Ostomy, and Tracheostomy Supplies
September 2025
As part of our broader comments on the CY 2026 Medicare Physician Fee Schedule (MPFS) and Outpatient Prospective Payment System (OPPS) proposed rules, LUGPA is raising strong concerns regarding CMS’s proposal to expand the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) to include urological, ostomy, and tracheostomy supplies.
Background
The DMEPOS Competitive Bidding Program was established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) to reduce costs for standardized items such as oxygen equipment and wheelchairs. While the MMA did not specifically exclude prosthetic supplies such as catheters, ostomy, and tracheostomy devices, CMS has historically refrained from including them in competitive bidding due to their highly individualized clinical use and critical role in sustaining vital bodily functions.
Patient and Physician Concerns
LUGPA physicians routinely prescribe and manage urological supplies—most commonly catheters—for patients with prostate disease, neurogenic bladder, and other serious conditions. These devices are not interchangeable. A patient’s catheter must be carefully selected based on anatomy, diagnosis, and medical history. The wrong product can quickly lead to infections, skin breakdown, trauma, or hospitalization.
Competitive bidding, by design, favors the lowest-cost option over the most clinically appropriate one. This approach would restrict physician-directed care, reduce patient choice, and introduce unnecessary risks. Delays, shortages, or substitutions that are already common in the supply chain could escalate into costly and preventable emergency interventions.
Congressional Intent and Statutory Protections
For more than two decades, CMS has protected access to these prosthetic supplies by excluding them from competitive bidding. Unlike standardized “off-the-shelf” equipment, catheters and related devices must be individually fitted to restore or maintain essential functions such as urinary, waste, or airway management. Expanding the CBP to include these items would depart from long-standing precedent and raise significant concerns about access and clinical appropriateness.
Evidence from Past Bidding Rounds
Prior CBP rounds have demonstrated clear risks: reduced supplier participation, delivery delays, and lower-quality product substitutions. While CMS points to cost savings, both studies and stakeholder experience suggest that disruptions often lead to downstream costs in the form of complications and hospitalizations. These risks are amplified for medically complex prosthetic supplies.
LUGPA’s Position
LUGPA urges CMS to withdraw this proposal and maintain protections that safeguard patient access to essential urological, ostomy, and tracheostomy supplies. Expanding the CBP to these devices would jeopardize patient safety, undermine physician-directed care, and increase Medicare costs through avoidable complications.
As we have emphasized in our broader comments on the MPFS and OPPS proposed rules, Medicare policies must prioritize patient outcomes, preserve clinical decision-making, and support cost-effective care in independent physician practices.
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