National Osteoporosis Foundation Makes Recommendations to CMS
A National Osteoporosis Foundation (NOF) report highlights substantial differences across the states in the number of fractures caused by osteoporosis and their resulting costs and deaths. The NOF made recommendations to the Centers for Medicare & Medicaid Services to improve care for osteoporosis.
The reports also document racial disparities in screening and outcomes, including lower screening rates and higher rates of death for Black Medicare fee-for-service beneficiaries following a bone fracture.
Other key report findings include:
• Approximately 2.1 million osteoporotic fractures were suffered by 1.8 million Americans covered by Medicare in 2016. The incremental annual allowed medical cost for osteoporotic fractures was $21,564 per Medicare FFS beneficiary in 2016.
• Medicare FFS beneficiaries suffered additional subsequent fractures within one year of the initial fracture at over three times the annual rate of new osteoporotic fractures for all Medicare FFS beneficiaries. In the six-month period following subsequent fractures that were suffered up to three years following an initial fracture in 2016 the cost was $5.7 billion.
• Preventing between 5 percent and 20 percent of these subsequent fractures could have saved between $272 million and $1.1 billion for the Medicare FFS program during a follow-up period that lasted up to three years after a new osteoporotic fracture.
The NOF contracted with the independent actuarial firm Milliman to analyze the state-by-state economic and clinical impact of bone fractures suffered by Americans insured by Medicare. The 50 individual state reports provide a first-ever detailed state-level review of the incidence of osteoporotic fractures, their healthcare impact and associated Medicare costs.
In terms of ethnic/ race variations, the report notes that while Black Medicare FFS beneficiaries had lower rates of fracture, only 5 percent received screening for osteoporosis with a bone mineral density (BMD) test within 6 months of a new osteoporotic fracture – when the need for treatment and action is highest – compared to 8 percent of all Medicare FFS beneficiaries with a fracture. In addition, 22 percent of Black Medicare FFS beneficiaries died within 12 months of a fracture, exceeding the national average rate of 19 percent and rates for White (19 percent), Asian (16 percent), Hispanic (18 percent) and North American Native (18 percent) beneficiaries.
“The healthcare system is failing the more than 54 million people who have osteoporosis or low bone density and are at high risk of breaking bones,” said Claire Gill, CEO of NOF, in a statement. “We have the tools to substantially reduce the enormous burden of osteoporotic fractures, and there are simple steps the Biden Administration and Congress can take to incentivize their use.”
The NOF made several recommendations based on the report, including:
• Congress and CMS should make changes to Medicare payments to incentivize widespread use of model secondary fracture prevention/care coordination practices for beneficiaries who have suffered an osteoporosis-related fracture and are thus at risk for another fracture.
• Cuts to Medicare payment rates for osteoporosis screening, which have reduced access, should be reversed either administratively or by legislation.
• Medicare pays for FDA-approved drug treatments for osteoporosis that can help reduce spine and hip fractures by up to 70 percent and cut secondary (repeat) fractures by about half. But about 80 percent go untreated, even after a fracture. Congress should mandate and fund a national education and action initiative aimed at reducing fractures among older Americans.
