By Dr. Diego Schaps
Every surgeon makes a promise to their patients. We cannot always promise a cure or that complications will not happen. But we can promise to: one, do everything in our power to achieve the best possible outcome — and two, work to find them the resources they need to recover and return to a healthy life.
A new Medicare policy is making me wonder whether I can still make that second promise.
I regularly care for patients with colorectal cancer, traumatic injuries, and inflammatory bowel disease. For many, an ostomy — a surgically created opening that allows waste to leave the body into a pouch — is a life-saving or lifestyle-saving operation. But surgery is only the beginning. Successful recovery depends on reliable access to pouching systems, skin barriers, and adhesives that fit patients’ bodies and work for their daily lives.
Those supplies are highly individualized medical prosthetics that patients often spend weeks — or months — working with clinicians and medical equipment providers to get right. When patients find the right fit, they regain the independence that surgery was meant to restore.
When they do not, the consequences are painful, frustrating, and often costly. A poorly fitting pouch can allow waste to sit against the skin, causing painful irritation, breakdown, and infection. It can also leak or come off entirely — disrupting daily life and making it difficult to leave home. These issues can also lead to emergency room visits and hospitalizations.
Unfortunately, the federal government is moving forward with a competitive bidding program that could make these issues far more common.
Instead of ensuring patients receive the products that work best for them, this new program could force them to rely on whatever products a contracted supplier happens to carry.
Medicare uses competitive bidding to lower what it pays for certain medical equipment by having suppliers compete for Medicare contracts. For the first time, ostomy suppliers will participate.
Medicare argues that the new rule will still protect patients because it allows clinicians to prescribe a particular brand when medically necessary. That safeguard sounds reassuring. But it also exposes the fundamental mismatch between competitive bidding and ostomy care.
When CMS created this safeguard, it said prescribing a particular brand would rarely be necessary because products within the same billing code perform the same therapeutic function.
That’s not the case in ostomy care. Two products may serve the same general function and still perform very differently on an individual patient’s body. The shape of a barrier, its flexibility, convexity, and adhesive properties, can all determine whether a patient maintains a seal or develops leakage and injury.
If patients can’t obtain the products that fit them properly, they may be forced to use products that don’t work as well. Any savings achieved by paying less for ostomy supplies could easily be offset by higher spending on wound care and treatment for preventable complications. A procurement system that lowers the price of supplies while increasing the overall cost of patient care is not a success.
Congress should postpone the competitive bidding program for urology and ostomy products, giving policymakers, clinicians, and patient advocates time to fully assess its impact on patient access.
Regardless of what happens, I will keep coming up with creative solutions to ensure that every patient who grants me the privilege to participate in their care has the best life possible after surgery.
Dr. Diego Schaps is a general surgery resident at Duke University Health System and a member of the advocacy board for United Ostomy Associations of America. This piece originally appeared in the DC Journal.