35 National Health Organizations Call on Medicare to Use 2025 Payment Rule to Improve Patient Care and Prevent Osteoporosis-Related Broken Bones

ARLINGTON, Va., Sept. 12, 2024 /PRNewswire/ -- There needs to be immediate action on providing appropriate post-fracture care for America's seniors, said 35 diverse national patient and health professional organizations. These organizations joined together in urging the Centers for Medicare & Medicaid Services (CMS) to substantially improve care for the 10 million Americans with osteoporosis by reducing the over two million painful and costly fractures they suffer each year. The organizations asked CMS to include in its final 2025 Medicare Physician Fee Schedule (PFS) regulation a payment mechanism that adequately covers the costs of proven post-fracture care coordination services known as fracture liaison services (FLS). FLS is standard of care in many countries and in some U.S. leading health systems like Kaiser and Geisinger. More than 100 studies have demonstrated fracture liaison services reduce fracture risks and saves money, but due largely to faults in Medicare payment policy, it is unavailable to most Medicare beneficiaries.

Medicare's draft PFS regulation issued in July took an important first step by recognizing that post-fracture osteoporosis follow-up services are "high-value, potentially underutilized services," including proposed new coding and inviting stakeholder input on payment policies and mechanisms that might address access barriers.

In their comments submitted on September 9^th, the 35 organizations, led by the Bone Health and Osteoporosis Foundation (BHOF) and the American Society for Bone and Mineral Research (ASBMR), thanked CMS for recognizing the need to address the crisis in osteoporosis care that leads to more hospitalizations than heart attacks, strokes, or breast cancer and will cost the nation over $95 billion by 2040 without reforms. However, the groups wrote that their analysis of CMS' proposed code sets "will likely have minimal impact in closing the care gap in secondary fracture prevention."

The groups point out that the utility of proposed advanced primary care management codes identified by CMS as potentially addressing the osteoporosis care gap "would be severely limited as they are intended for use within advanced payment models and require the clinician to assume all primary care responsibilities for the patient. Although some post-fracture care programs are provided within primary care practices, most reside within other specialties, including orthopedics, rheumatology, and endocrinology."

"We commend CMS for recognizing the urgent need to address the crisis in post-fracture care for osteoporosis patients and ask them to now respond with a coding mechanism that provides Medicare beneficiaries with the standard of care they deserve," said Claire Gill, CEO of BHOF. "This proven model of post-fracture care will save billions of taxpayer dollars and, more importantly, save millions of lives."

"ASBMR adds its appreciation to CMS for responding to the bone health community's request to make the evidence-based post-fracture care proven to reduce repeat fractures and reduce costs the norm rather than the exception," said Douglas Fesler, Executive Director, ASBMR. "We are now calling for them to finish the job in this final Medicare regulation."

The groups' letter also called on CMS to make changes to its TEAM payment model requiring many hospitals to refer fracture patients to primary care for follow up. Without further direct incentives for FLS, the groups told CMS that "fracture patients will go without quality care as primary care doctors have very little time, not enough experience or any payment incentive to make this happen." 

About the Bone Health and Osteoporosis Foundation
Established in 1984, the Bone Health and Osteoporosis Foundation is the nation's leading health organization dedicated to promoting strong bones for life, preventing osteoporosis and broken bones, and reducing human suffering through programs of awareness, education, advocacy, and research. For more information on the Bone Health and Osteoporosis Foundation, visit www.bonehealthandosteoporosis.org. 

About the American Society for Bone and Mineral Research
The American Society for Bone and Mineral Research (ASBMR) is the leading professional, scientific and medical society established to bring together clinical and experimental scientists involved in the study of bone, mineral and musculoskeletal research. ASBMR encourages and promotes the study of this expanding field through annual scientific meetings, two official journals (Journal of Bone and Mineral Research^® and JBMR^® Plus), the Primer on Metabolic Bone Diseases and Disorders of Mineral Metabolism, advocacy and interaction with government agencies and related societies. To learn more about upcoming meetings and publications, please visit www.asbmr.org.

Contact: Claire Gill, BHOF CEO
703-647-3025
[email protected]

SOURCE Bone Health & Osteoporosis Foundation