Mail order lacks safeguards

Thursday, July 31, 2008

WASHINGTON--Medicare’s competitive bidding program for mail order diabetes supplies has no basic consumer protections and standards for safety, according to a new study by George Washington University.

“All of the protections that one could think of are totally missing here,” said Sara Rosenbaum, a professor and chair of the university’s Department of Health Policy, and one of the co-authors of “Medicare Bidding Program Could Impede Senior’s Access To Diabetes Testing Supplies.”

Chief among her concerns: a lack of either an appeals or complaints system; lack of access for non-English speakers or those with disabilities who may be unable to use a phone or the Internet; and loopholes in the cold-calling prohibition.

“What you want is people making an informed voluntary decision to buy by mail order after having seen the products and talking to their doctor or provider,” said Rosenbaum. “If companies are just signing people up with no standards and just shipping the product, there is no requirement that the vendor have a help line to immediately turn off an inappropriate shipment.”

If that happens, and incorrect supplies continue to be shipped and billed for weeks or months, government waste and costs rise, she said.

“Either people would just go to the local store and buy what they need or, you could get someone who doesn’t have the capacity to replace everything or doesn’t understand that’s even an option,” said Rosenbaum. “People think that if you get a unit discount price, you save money. That is just not true if volume goes through the roof.”

Mail order, says Rosenbaum, is a consumer-driven model that depends on savvy shoppers with a high-degree of literacy to do comparison shopping. That is not the typical profile of a Medicare beneficiary with diabetes, she said.

“(It doesn’t fit) lower-income folks who are much less health literate because of their income and the greater burdens they carry in their daily lives,” said Rosenbaum. “The deep concern here is if this (model) in some way goes bad, it undermines the imperative to have constant testing.”