Ready-Made Medicare Reforms Would Prevent Costly Broken Bones

Osteoporosis, or weakening of the bones, is not often included in discussions of major health policy concerns, yet bone fractures due to osteoporosis are responsible for more hospitalizations than heart attacks, strokes or breast cancer. They are also costly. The direct medical costs of Medicare beneficiaries who suffer two or more bone fractures was $5.7 billion.

The good news is that Congress and the Biden administration can take a few commonsense steps that would both reduce Medicare costs and save lives. Preventing only 1 in 5 of secondary fractures could save Medicare over $1 billion in two to three years.

A new study by the independent actuarial firm Milliman finds that 1.8 million Medicare beneficiaries suffered about 2.1 million bone fractures linked to osteoporosis in 2016. Nationally, for those patients within traditional Medicare (not including those in Medicare Advantage plans) who suffered an osteoporotic fracture, the following was true:

• More than 40 percent were hospitalized within one week after the fracture, across all types of fractures studied. Of those with a hip fracture, more than 9 in 10were hospitalized within a week.
• They had twice the annual rate of debilitating and costly new pressure ulcers after adjusting for age and sex.
• Almost 42,000 became institutionalized in nursing homes within three years, as the debilitating effects post fracture required the custodial care provided in a nursing home.

The report found that while Black Americans suffer fewer fractures, they have higher hospitalization rates, higher death rates following fractures and lower bone mineral density screening rates. Other studies have reported racial disparities in fracture incidence and post-fracture outcomes — particularly higher rates of mortality, debility and destitution following a fracture among Black women when compared to that of Caucasian women.

Not surprisingly, the financial toll on Medicare will continue to grow as the baby boomers age. Another recent study found that the total annual cost for osteoporotic fractures among Medicare beneficiaries was $57 billion in 2018. Without reforms, the cost is expected to grow to over $95 billion by 2040.

Unlike with other costly conditions — such as Alzheimer’s disease — which still need more research to improve patient outcomes, we know exactly what needs to be done to prevent secondary fractures. Medicare already pays for state-of-the-art bone density testing to identify those at risk of bone fractures, allowing for early and effective preventive steps and interventions.

Medicare also pays for Food and Drug Administration-approved drug treatments for osteoporosis that can help reduce spine and hip fractures by up to 70 percent and cut repeat fractures by about half. In addition, new models of coordinated, post-fracture care like those provided at Geisinger Health System have proven to reduce rates of fractures.

Tragically, these effective tools are largely going unused, allowing preventable fractures to continue. Only 8 percent of beneficiaries in traditional Medicare received bone density screening within six months of suffering an osteoporotic fracture. Other studies have shown that around 80 percent of those who have suffered a fracture have not received effective drug therapies to help prevent additional fractures.

This is unacceptable. There are two ready-made policy changes that Congress and the Biden administration can take to save lives and money.

First, modernizing Medicare payments to incentivize widespread use of best practices for secondary fracture prevention and care coordination for beneficiaries who have suffered an osteoporosis-related fracture would dramatically improve care rates. Using these best practices, Geisinger Health System in Pennsylvania has raised fracture prevention treatment rates to over 70 percent among those at high risk.

Second, in the last five years the osteoporosis diagnosis of older women has declined by 18 percent. This is not because osteoporosis has become less common, but because Medicare payment rates for osteoporosis screening have been cut by 70 percent. These cuts should be reversed either administratively or by legislation.

There are many health care issues that need to be resolved. However, we know how to help the 10 million Americans who suffer from osteoporosis. We also know that these ready-made reforms are not expensive but will actually save taxpayers billions and help keep Medicare solvent.

Claire Gill is chief executive officer of the National Osteoporosis Foundation, based in Arlington, Va.

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