By Madonna Long
When I was 18 years old, I was paralyzed in a school bus accident. For the past four decades, I’ve relied on catheters to do something most people never have to think about: go to the bathroom.
My catheter isn’t optional. It’s not a convenience. It’s the difference between going about my daily life independently and ending up in the hospital.
Finding the right supplies for my body took a lot of trial and error — and a lot of support from my doctor and medical equipment provider. I faced my share of painful setbacks. When people like me find something that works, we stick with it.
Now, an arcane federal rule could take all that away.
The Centers for Medicare and Medicaid Services are planning to restart and expand the “competitive bidding” program that would hand contracts for urological and ostomy supplies to less than 10 companies for the whole country — that’s a 92% reduction in urological and ostomy medical supply companies nationwide.
If someone’s current medical equipment provider doesn’t win one of those contracts, they’ll be forced to switch. Forced to start over. And forced to gamble with their health.
Policymakers in Washington need to understand that supplies like mine are not interchangeable. They are not generic commodities that can be swapped out like paper towels or plastic bags. They are individualized medical necessities.
There are more than 1,300 different intermittent catheter products on the market, each with meaningful differences in size, flexibility, coating, and design. Doctors choose them based on a patient’s anatomy, dexterity, and underlying condition.
That level of customization isn’t a luxury. It’s what keeps people like me out of the hospital. Because the wrong product can cause life-threatening infections.
Urinary tract infections are among the most common and dangerous complications for people who rely on catheters. In severe cases, those infections can turn into sepsis — a leading cause of hospitalization.
I’ve dealt with infections before. I know how quickly things can spiral, from discomfort to emergency care.
For ostomy patients, an ill-fitting system can lead to leakage, skin problems, and infection. One analysis found that more than one-third of ostomy patients develop skin complications within 90 days of surgery. Those complications can be dangerous — and often require medical intervention or admission to the hospital.
The costs — to both patients and the broader healthcare system — are high. In other words, this competitive bidding program, which is intended to reduce costs, could raise them in the long run.
The program could have additional unintended consequences. It requires companies to operate nationwide, with the scale and infrastructure to serve patients across the country. In practice, that makes it difficult — if not impossible — for many smaller, community-based medical equipment providers to compete.
That matters more than people realize.
I’m not just a patient. I also run a medical supply business. I see firsthand how personal this care is. Medical equipment providers don’t just ship products. They educate patients, understand their history, help them avoid complications, and maintain regular contact.
Under this new system, those relationships could disappear overnight. Instead, patients could be pushed to distant companies that don’t know us, don’t understand our needs, and may not even offer the products that keep us healthy.
More than four in ten medical equipment providers are actively planning or considering not to provide urological and ostomy supplies because of market dynamics that will only be exacerbated under the competitive bidding program. Losing the ability to serve Medicare beneficiaries would force many of us to close.
In rural states like mine, the consequences could be even worse. If smaller companies are forced out, some patients may struggle to find any supplier at all, regardless of what health insurance they have.
Federal officials say the new rule is about saving money — about preserving Medicare’s fiscal sustainability. But cutting costs by destabilizing patients like me doesn’t eliminate spending. It shifts it.
If the new rule leads to more infections, more complications, and more hospital visits, Medicare won’t save money. It will spend more elsewhere. And patients will pay the price in pain, fear, and lost dignity.
I saw as much firsthand during a previous round of competitive bidding for wheelchairs — my primary mode of transportation.
CMS still has time to learn from its past mistakes — and rethink its strategy. Failing that, Congress should step in — and ensure that patients retain access to the urological and ostomy supplies and the medical equipment providers they depend on.
This rule may look like a line item on a spreadsheet in Washington. But it will determine whether people like me can live our lives — or whether we’re pushed back into a cycle of illness and uncertainty.
Madonna Long uses a catheter after a bus accident left her with a spinal cord injury when she was 18 and is founder of Summit Services & Supplies.