The GAO has released correspondence to Congress on “Issues for Manufacturer-Level Competitive Bidding for Durable Medical Equipment.” The letter describes how some health care purchasers use a “manufacturer-level approach” (in contrast to Medicare competitive bidding’s supplier-level approach) to buy DME items directly from DME manufacturers or through a purchasing intermediary (such as a group purchasing organization) to obtain savings by leveraging their purchasing power. The report also describes issues that CMS might face if it were required to implement a DME manufacturer-level approach to bidding.