The Centers for Medicare and Medicaid Services has decided to include ostomy supplies in its competitive bidding program (CBP), limiting supplier choice in the name of cost savings. Finalized last November, the policy is already moving toward implementation with key decisions on pricing and the number of contracts to award for each product category expected as soon as this spring.
The goal is understandable. The reasoning is not.
In more than 700 pages, CMS offers almost no ostomy-specific analysis, relying instead on extrapolation from other durable medical equipment and a single flawed ostomy data point to justify a policy affecting the roughly 1 million Americans living with an ostomy.
Ostomies are surgically created openings on the abdomen that allow stool or urine to exit into a bag, and about 100,000 people get one every year. Ostomies are often lifesaving, but they are also work. Patients with ostomies rely on specialized supplies that are evaluated and changed over time to maintain a seal, protect their skin, and function normally.
I reviewed the CMS decision to understand its rationale. I am a surgery resident, lead a VA ostomy program, and serve on United Ostomy Associations of America’s advocacy committee. I care for these patients regularly. When supplies fit well, patients live full, independent lives. When they do not, the consequences are predictable: leakage, skin breakdown, emergency department visits, and hospitalizations. Limiting access to appropriate supplies will not reduce costs. It shifts them downstream.
CMS proposed including ostomy supplies in the CBP in July 2025, triggering a public comment period. During that time, clinicians, patients, advocacy groups, and industry stakeholders submitted extensive comments opposing the change. These efforts were reinforced by two congressional letters to CMS and numerous meetings on Capitol Hill. Throughout, the message has been consistent.
CMS’s response to these efforts arrives on page 496 of its November 2025 ruling where it finally cites ostomy data. This comes in the form of a single data point in a more than 700-page policy used to justify a decision affecting more than one million people. Worse, it’s misleading.
CMS points to increased spending for billing code A4407, a type of convex ostomy barrier, rising from about $13 million in 2003 to about $37.4 million in 2022. This is presented as evidence of inefficiency.
That conclusion does not hold up under closer scrutiny.
Adjusting for inflation using the Consumer Price Index brings the original $13 million to roughly $20 million in 2022. That explains a large portion of the increase.
The remaining explanation is straightforward to anyone who works with ostomy patients. It has to do with a type of ostomy supply called a convex barrier.
Convex barriers were designed for patients whose ostomies sit flat or below the skin or whose abdominal contours make it difficult to maintain a seal. There are clear reasons why use of these products has increased, making them a poor proxy indicator.
First, patients are surviving serious illnesses at higher rates. During emergency surgery, it is not always possible to create an ideal ostomy. These patients are more likely to require convex barriers. At the same time, obesity rates have risen. A thicker abdominal wall and deeper skin folds make it harder for a stoma to protrude, increasing the need for convex products.
Ostomy care has also evolved. Two decades ago, convex barriers were used more sparingly due to concerns about pressure injury. With improved design and understanding, those concerns have largely been addressed. Today, convexity, which can be more expensive, is used earlier and some experts recommend a convexity-first approach after ostomy surgery.
Taken together, these trends offer a straightforward explanation for increased use. They reflect changes in populations and improvements in care, not evidence of waste. CMS has presented no meaningful data to support claims of inefficiency in ostomy supplies, relying instead on evidence from other durable medical equipment.
This situation reflects a broader issue: lack of respect for and understanding of ostomy care.
Ostomy care has long been underfunded and understudied, leading to data that are sparse and of lower quality. Now a national policy that risks worsening care and eroding patient dignity is being justified by a single, flawed data point.
Limiting access to supplies is misguided when a pouching system, fitted by experts, is what allows people to live normally. I have seen patients alter where they go and how they live out of fear of leakage.
But consequences extend beyond quality of life. As access declines, downstream complications and costs will rise. I have cared for patients who need help not because their disease worsened, but because they could not maintain a seal at home and this led to significant skin issues. These problems already occur daily and will worsen if access is restricted.
CMS has already finalized this policy. If possible, CMS must reconsider this ill-advised decision. If not, the responsibility now shifts to Congress. Lawmakers must pass legislation that clarifies that ostomy supplies are not appropriate for inclusion in competitive bidding programs and should be treated as patient-specific systems, not interchangeable goods.
Cost control is important. But it must be grounded in an accurate understanding of the care being delivered. In this case, a national policy affecting 1 million Americans rests on an incomplete interpretation of a single billing code. That is not how decisions like this should be made.
Diego Schaps, M.D., M.P.H., is general surgery resident at Duke University Health System, a member of the United Ostomy Associations of America advocacy committee, and a Department of Veterans Affairs quality scholar. These opinions are held by the author and do not represent any position held by the U.S. government, the Department of Veterans Affairs, or Duke University.
