Recently, a bipartisan group of United States Senators sent a letter to Shalanda Young, the director of the Office of Management and Budget (OMB), about Fracture Liaison Services and how they may be able to be improved through the Centers for Medicare and Medicaid Services (CMS). In the letter, Senators John Barrasso, MD, Ben Cardin, Shelley Moore Capito, and Susan Collins, note that post-fracture osteoporosis care services can be an important aspect of the healthcare system as osteoporosis is a “systemic, metabolic skeletal disease, characterized by reduced bone quality and decreased bone mass with destruction and deterioration of bone micro-structure.”
The Senators further note that many Medicare beneficiaries who suffer from an osteoporotic fracture are not getting the follow-up care necessary to reduce the potential of future fractures. In fact, they cite a 2021 Milliman report that found that Medicare Fee-For-Service (FFS) beneficiaries who suffer from one osteoporotic fracture were three times more likely to suffer another fracture within the year. For patients who suffered a hip fracture, 30% of them died within a year and nearly 42,000 patients with osteoporotic fractures were in nursing homes within three years.
With the population aging, the Senators predict that the problem will increase over time, with an estimated 68% increase in osteoporotic fractures by 2040 and associated costs of more than $95 billion. Not only is there a financial cost, but osteoporotic fractures have “devastating outcomes for a predominantly female population,” as 80% of women who suffer an osteoporotic fracture fail to receive the treatment that could prevent a future fracture.
Unfortunately, given the challenges that exist in preventing osteoporotic fractures, the Senators believe that patient care should be prioritized for the fractures by “updating Medicare policies to establish a care coordination payment mechanism for secondary prevention of osteoporotic fractures that reimburses providers for post-fracture assessment (including fall risk), care coordination and collaboration, diagnosis, treatment planning, treatment initiation, and follow-up care.” Such additional measures could save lives, close a “significant care gap for women,” and reduce the risk of opioids, among other benefits.
Specifically, the Senators call on CMS and OMB to review and consider the proposal submitted by provider and patient advocacy groups on improving Fracture Liaison Services. The proposal includes revised Medicare coding and payment policies built on a payment model already created by CMS for conditions such as opioid use disorder. The model would include a “viable way” for providers to give fracture patients the coordinated and collaborative follow-up care they need, including by requiring appropriate osteoporosis and fall risk assessments and coordination of care to address low bone density and reduce the risk of falls. The goal would be to help the patient at the “first” fracture and treat the underlying chronic disease to prevent subsequent fractures.