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Health Status Monitoring

On January 1, 2011, the Centers for Medicare & Medicaid Services (CMS) launched the first phase of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program in nine different areas of the country. In order to protect the interests of potentially affected Medicare beneficiaries, CMS has been conducting real-time claims analysis to monitor health status for groups of Medicare beneficiaries in competitive bidding areas (CBAs). Health status results are shown in the files on this page. Each file includes a written summary of results and graphical displays of key indicators reflective of the health status of beneficiaries and their access to DMEPOS items and services. The data is derived from claims for Medicare populations in each CBA and a corresponding "comparator" region that is similar to the CBA. CMS initially published monthly updates to this information. Because the first full year of data indicated no change in beneficiary health status outcomes resulting from the competitive bidding program, CMS is now issuing quarterly updates. See the Downloads section below for the latest results.

Note: Beginning with the first quarter of 2015, the files have been updated to incorporate the changes to our monitoring approach that commenced at the end of the Round 1 Rebid program on December 31, 2013, and due to the availability of complete data for the first full year of the Round 1 Recompete program that was implemented January 1, 2014. These changes include:

  • Monitoring usage and health outcomes related to six additional product categories (Transcutaneous Electrical
         Nerve Simulator (TENS), Nebulizers, Infusion Pumps, Commode Chairs, Seat Lifts, and Patient Lifts) that were
         introduced under Round 1 Recompete. We monitor usage and health outcome rates in six corresponding utilizer
         groups, and seven access groups. For the infusion pump product category, we monitor rates in two separate
         access groups.
  • Monitoring both Round 1 Recompete and Round 2 using the list of Healthcare Common Procedure Coding
         System (HCPCS) codes that are covered by Round 1 Recompete.
  • Comparing trends between the three groups of beneficiaries.

If you would like to reference how the access groups were previously defined, please view the archive folder below.