National Patient and Medical Groups Praise CMS
for "Giving Patients Hope" and Call for Further Action
ARLINGTON, Va., July 18,
2024 /PRNewswire/ -- 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.
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 or
cgill@bonehealthandosteoporosis.org
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SOURCE Bone Health & Osteoporosis Foundation