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Supplemental Oxygen Use in Patients with COPD after the 2016 Implementation of the Medicare Competitive Bidding
Kevin I Duan1,2,3, Emmi Obara4,5, Edwin S Wong5,6
1Division of Respiratory Medicine, University of British Columbia, Vancouver, Canada.
Rationale:
The Medicare Competitive Bidding Program (CBP), a policy that reduces durable medical equipment reimbursement rates through a bidding process, was expanded nationwide in 2016. Lower bid-derived prices may affect supplemental oxygen access, but little is known about the 2016 policy impact.
Objective:
Evaluate the association between the 2016 implementation of CBP and supplemental oxygen use among patients with chronic obstructive pulmonary disease (COPD).
Methods:
We used fee-for-service Medicare data of beneficiaries with COPD enrolled between July 1, 2009 and June 30, 2017, to conduct a single-group interrupted time series analysis of the 2016 expansion of CBP.
Measurements:
Primary outcomes were measured at the ZIP-month, including the proportion of COPD beneficiaries with a new oxygen claim, and the proportion of COPD beneficiaries on supplemental oxygen that had oxygen claims discontinued.
Main Results:
CBP expansion was not associated with a change in the monthly proportion of new oxygen claims at policy implementation [-0.0084 percentage points (ppt); 95% confidence interval (CI) -0.024, 0.0077], but was associated with a small decrease in monthly trend afterwards (-0.0054 ppt; 95%CI -0.0078, -0.0032). For discontinuation of oxygen claims, CBP expansion was associated with a small increase in the monthly proportion of discontinuations at policy implementation (0.24 ppt; 95%CI 0.14, 0.35), but no change in the post-policy trend (0.010 ppt; 95%CI -0.0051, 0.026).
Conclusions:
Medicare CBP nationwide expansion in 2016 was not associated with a clinically meaningful change in oxygen use among beneficiaries with COPD and do not support removal of supplemental oxygen from the CBP.
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