Urology Advocates Urge Safeguards in Medicare Catheter Bidding

The American Association of Clinical Urology (AACU) and the Wound, Ostomy and Continence Nurses Society (WOCN) have raised concerns about the inclusion of urological and ostomy supplies in the competitive bidding program for durable medical equipment.

The Centers for Medicare & Medicaid Services (CMS) has designated urological supplies, ostomy supplies and hydrophilic urinary catheters as product categories for Round 2028 of the bidding program to be included in a nationwide remote item delivery program. Under that model, only contract suppliers may furnish competitively bid items covered by Medicare Part B, and each contract supplier must serve beneficiaries across the country.

CMS said it expects the round to begin no later than Jan. 1, 2028, with a six-month transition period. The agency said it has also created important safeguards. When a physician prescribes a particular brand or mode of delivery to avoid an adverse medical outcome, a contract supplier must furnish it, help locate another contract supplier or consult the physician about an alternative. If the physician determines that the alternative is unacceptable, the supplier must provide the prescribed item.

In a recent article published in Urology Times (and highlightd by the American Asociation for Homecare) the AACU and WOCN emphasized that catheter and ostomy product selection is an individualized clinical decision and cautioned that inappropriate substitutions could lead to complications, loss of independence and additional healthcare utilization. They also highlight the potential administrative burden on clinicians if new documentation, product authorization or substitution requirements create delays in patient care.

The organizations outlined safeguards they believe CMS should implement if the program moves forward, including a streamlined physician authorization process, access to a meaningful range of products, timely delivery and replacement procedures and monitoring of patient outcomes and administrative burden.

“Before implementation, CMS should make the physician-authorization process simple, rapid and visible to patients, suppliers and clinicians,” the organizations wrote in the article, which listed the two groups as authors. “A prescription that identifies a brand, design, feature or mode of delivery as necessary to avoid an adverse outcome should be honored without serial appeals or repeated demands for the same records.

“Contract suppliers should maintain a meaningful range of products, sizes, designs and manufacturers,” they continued. “Substitution should never occur solely because another product costs less, and a clinically stable patient should not be forced to repeat a failed-product history merely to remain on an established regimen.”

The organizations also said CMS should also require timely delivery, emergency replacement procedures, transparent complaint reporting and early monitoring that can detect problems before they become national patterns. That oversight should include patients, urologists, WOC nurses and other clinicians who see the consequences of product failure firsthand.