Dr. Mark Olson: Osteoporosis Reform Saves Money and Improves Care

Dr. Mark Olson

Osteoporosis, or bone weakness, is rarely included in the discussion of major health policy concerns, but osteoporosis fractures cause more hospitalizations than heart attacks, strokes, or breast cancer. They are also expensive. Direct medical costs for Medicare recipients suffering from two or more fractures were $ 5.7 billion nationwide over three years and $ 107.5 million in Washington.

Fortunately, Congress and the Biden administration can take some common-sense steps to reduce health care costs and save lives here in Washington and throughout the country. In fact, by preventing only one-fifth of secondary fractures, Medicare can save over $ 1 billion in a couple of years.

In 2016, about 1.8 million Medicare recipients suffered about 2.1 million osteoporotic fractures, according to a new study by the National Osteoporosis Foundation. In Washington, 37,000 Medicare beneficiaries suffered 42,300 osteoporosis-related fractures, with more than $ 107 million in fractures.

Nationwide, for patients within conventional Medicare with osteoporotic fractures (excluding patients with the Medicare Advantage Plan):

• For all types of fractures investigated, more than 40% were hospitalized within 1 week after the fracture. Of the patients with hip fractures, more than 9 out of 10 were hospitalized within a week.

After adjusting for age and gender, they became debilitated and doubled the annual rate of costly new pressure ulcers.

・ Approximately 42,000 people were institutionalized in nursing homes within three years because the debilitating effect after fracture required management care provided in nursing homes.

Not surprisingly, the effects of osteoporosis are expected to increase as the baby boomer generation grows older. According to another recent study, the total annual cost of osteoporotic fractures for Medicare recipients was $ 57 billion in 2018 and is expected to exceed $ 95 billion by 2040.

There are tools to solve this problem. Medicare is already paying for state-of-the-art bone mineral density tests to identify people at risk of fractures, enabling early and effective precautions and interventions. Medicare also bears the cost of FDA-approved medications for osteoporosis, which helps reduce spine and hip fractures by up to 70% and reduces recurrent fractures by about half. In addition, new models of adjusted post-fracture care have proven to be effective in reducing fracture rates.

Unfortunately, we are not using the tools we have. Only 9% of traditional Medicare Washington residents underwent bone mineral density screening within 6 months of suffering an osteoporotic fracture. And the screening rate for black beneficiaries in our state was even lower, with only 3.8% being screened. Other studies have shown that about 80% of people with fractures do not receive effective medications that help prevent additional fractures.

There are three steps that Congress and the Biden administration can take to address the issue. First, the Medicare & Medicaid Service Center should encourage the use of best practices for secondary fracture prevention and care coordination, such as the model used in the Gaisinger Health System in Pennsylvania.

Second, the reduction in Medicare payment rates for osteoporosis screening should be cancelled. Over the last five years, the diagnosis of osteoporosis in older women has decreased by 18%. This is not because osteoporosis has become less common, but because screening payments have been reduced by 70%.

Finally, we have made great strides in heart disease and other conditions through awareness campaigns. Congress needs to develop and fund national education and action initiatives aimed at reducing fractures in older Americans. Setting national goals for the prevention of osteoporosis and fractures and prioritizing the reduction of racial disparities has meaningful implications.

We know how to help Washington people suffering from osteoporosis, and the necessary reforms will save taxpayers billions of dollars and help maintain Medicare’s solvents. We hope that others in our state will participate in calling on our representatives, senators, and the Biden administration to take these common-sense steps.

Dr. Mark Olson is a Spokane orthopedic surgeon specializing in bone health and the examination and treatment of osteoporosis.