A new series of state-by-state reports released by the National Osteoporosis Foundation (NOF) highlighted substantial differences across the states in the number of fractures caused by osteoporosis and their resulting costs and deaths. The reports also documented racial disparities in screening and outcomes, including lower screening rates and higher rates of death for Black Medicare FFS beneficiaries following a bone fracture.
The NOF contracted with the independent actuarial firm Milliman to analyze the state-by-state economic and clinical impact of bone fractures suffered by Americans insured by Medicare. The reports provided a first-ever detailed state-level review of the incidence of osteoporotic fractures, their health care impact, and associated Medicare costs.
Key findings include:
- 1.8 million Americans covered by Medicare in 2016 suffered approximately 2.1 million osteoporotic fractures. The incremental annual allowed medical cost for osteoporotic fractures was $21,564 per Medicare FFS beneficiary in 2016.
- Medicare FFS beneficiaries suffered additional subsequent fractures within one year of the initial fracture at over three times the annual rate of new osteoporotic fractures for all Medicare FFS beneficiaries. In the six-month period following subsequent fractures that were suffered up to three years following an initial fracture in 2016, the cost was $5.7 billion.
- Preventing between 5% and 20% of these subsequent fractures could have saved between $272 million and $1.1 billion for the Medicare FFS program during a follow-up period that lasted up to three years after a new osteoporotic fracture.
State Variations:
- After adjusting for differences in age and sex, Medicare FFS beneficiaries in Hawaii had 24% lower rates of osteoporotic fractures than the national average, while Kentucky and Florida had the highest rates of fractures, 13% and 12% higher than the national average respectively.
- While the national average estimated 180-day incremental costs of a subsequent fracture was about $20,400, this varied significantly among states from a low of about $17,000 in Arkansas to a high of $26,200 in Wyoming.
Ethnic/Race Variations:
- While Black Medicare FFS beneficiaries had lower rates of fracture, only 5% received screening for osteoporosis with a bone mineral density (BMD) test within six months of a new osteoporotic fracture – when the need for treatment and action is highest – compared to 8% of all Medicare FFS beneficiaries with a fracture.
- 22% of Black Medicare FFS beneficiaries died within 12 months of a fracture, exceeding the national average rate of 19% and rates for White (19%), Asian (16%), Hispanic (18%), and North American Native (18%) beneficiaries.
- About 6% and 7% of North American Native and Hispanic Medicare FFS beneficiaries, respectively, received a BMD test within six months of a new fracture compared to 8% among all Medicare FFS beneficiaries.
“The health care system is failing more than 54 million people who have osteoporosis or low bone density and are at high risk of breaking bones,” said Claire Gill, CEO of NOF. “We have the tools to substantially reduce the enormous burden of osteoporotic fractures, and there are simple steps the Biden Administration and Congress can take to incentivize their use.”
The NOF made several recommendations based on the report, including:
- Congress and CMS should make changes to Medicare payments to incentivize widespread use of model secondary fracture prevention/care coordination practices for beneficiaries who have suffered an osteoporosis-related fracture and are thus at risk for another fracture.
- Cuts to Medicare payment rates for osteoporosis screening which have reduced access should be reversed either administratively or by legislation.
- Medicare also pays for FDA-approved drug treatments for osteoporosis that can help reduce spine and hip fractures by up to 70% and cut repeat fractures by about half. But about 80% go untreated, even after a fracture. Congress should mandate and fund a national education and action initiative aimed at reducing fractures among older Americans.
Pamela Pelizzari, a Milliman co-author, said, “The findings in this report highlight the substantial disease burden resulting from osteoporosis-related fractures among Medicare FFS beneficiaries. The state-level reports highlight both variability across populations and opportunities for improvements in osteoporosis management.”
Edited by Maryssa Gordon, Senior Editor, Price of Business Digital Network
