Medicare’s Proposed 2025 PFS Rule Takes Critical First Steps to Improve Post-Fracture Care for Osteoporosis Patients in the U.S.
Medicare’s Proposed 2025 PFS Rule Takes Critical First Steps to Improve Post-Fracture Care for Osteoporosis Patients in the U.S.
National Patient and Medical Groups Praise CMS for “Giving Patients Hope” and Call for Further Action
The proposed 2025 Medicare Physician Fee Schedule (PFS) rule issued by the Centers for Medicare & Medicaid Services (CMS) last week recognizes the need to substantially improve care for the 10 million Americans who suffer from osteoporosis, almost two million of whom suffer painful fractures each year. In its proposed rule, CMS proposes payment changes to incentivize better care. This follows three years of efforts led by the Bone Health and Osteoporosis Foundation (BHOF) and the American Society for Bone and Mineral Research (ASBMR) as well as a broad coalition of patient advocacy, health professional organizations, and Congressional offices calling on the agency to help reduce the rapid rise in costly and deadly osteoporotic fractures suffered by Medicare beneficiaries. Half of all women and one out of every four men over the age of 50 will suffer a fracture due to osteoporosis in their lifetime, leading to more hospitalizations than heart attacks, strokes, or breast cancer. Total costs for osteoporotic fractures are expected to soar to $95 billion by 2040 without reforms.
“We commend CMS for recognizing the urgent need to address the crisis in post-fracture care for osteoporosis patients and taking the first step to incentivizing better care, which gives patients hope,” said Claire Gill, CEO of BHOF. “On behalf of the 10 million Americans with osteoporosis, we thank CMS, our colleagues in the bone health and osteoporosis community, our Congressional Bone Health Champions, and all who have been working with us to promote improved care.”
More than 31 organizations representing patient advocacy, research, and medical societies signed on to letters to CMS urging them to ensure their policies encourage clinicians to provide evidence-based, proven interventions intended to prevent secondary fractures in our aging population.
“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. “For the over 1.8 million Medicare beneficiaries who suffer fractures every year, this proposed rule lays the foundation for making that happen.”
Specifically, CMS Included:
New coding… that might be used to bill for managing fractures under a treatment plan including the global post-operative add-on code HCPCS code GPOC1 in section II.G.5 … and the advanced primary care management codes in section II.G.2.”
Request for “public comment to understand more clearly how often evidence-based care for persons with fractures, for example, is not provided and the reasons for this, and how recent or new PFS codes or their revaluation might help resolve specific barriers to its provision.”
CMS’ recognition that post-fracture osteoporosis follow-up services are both high value and underutilized comes on the heels of a sweeping women’s health Executive Order issued earlier this year by President Biden, directing the Department of Health and Human Services (HHS) to “identify ways to improve … the clinical care that women receive” for diseases and conditions such as osteoporosis.
“BHOF, ASBMR, and our many partners have a lot of work to do over the next 60 days and look forward to meeting with CMS in this time to provide expertise on needed changes. But today we congratulate the Agency on its commitment to the underserved, especially women, the mast majority of whom have lived with inadequate post-fracture care,” said Gill. “We will also look forward to a final inpatient rule in which CMS and the Center for Medicare and Medicaid Innovation (CMMI) staff reflect needed changes to the recently proposed TEAM model to ensure that osteoporosis care is enhanced rather than diminished by the proposal.”
A few key background facts make the case for aligning incentives with quality post-fracture follow-up to reduce secondary fracture prevention:
1.8 million Medicare beneficiaries, 70 percent of them women, suffered approximately 2.1 million osteoporotic fractures every year.
30 percent of Americans who suffer a hip fracture die within a year.
42,000 patients are institutionalized in nursing homes within three years after suffering a hip fracture.
Only 20 percent of hip fracture patients receive medication proven to greatly reduce the risk of a second fracture. By comparison, 95 percent of heart attack patients receive medication to prevent another heart attack.
Only 8 percent (and only 5 percent of Black Americans) are even screened for osteoporosis within 6 months of a fracture.
23% of opioid-naïve hip fracture patients became chronic opioid users after surgery.
BHOF and ASBMR thank the many partners who have worked diligently for over three years on this effort, including the American Orthopaedic Association, members of the National Bone Health Policy Institute’s Coalition to Strengthen Bone Health, the members of ASBMR’s Secondary Fracture Prevention Initiative, and BHOF’s Congressional Bone Health Champions including Senators Baldwin (WI), Barrasso (WY), Capito (WV), Cardin (MD), Collins (ME), and Murray (WA), and Representatives Burgess (TX), Cammack (FL), Larson (CT), Lee (NV), and Sanchez (CA), who have written, called, and met with CMS and the multiple years of Congressional Appropriations directives to HHS in support of this action.
The press release can be found here: https://www.prnewswire.com/news-releases/medicares-proposed-2025-pfs-rule-takes-critical-first-steps-to-improve-post-fracture-care-for-osteoporosis-patients-in-the-us-302200667.html.
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
cgill@bonehealthandosteoporosis.org