America's Benefit Specialist July 2023

MEDICARE MATTERS

Senators Cardin, Barrasso, Collins and Capito recently sent a letter to the director of the Office of Management and Budget. The letter encourages the administration to update Medicare policies to establish a care-coordi nation payment mechanism for secondary prevention of osteoporotic fractures that reimburses providers for post-fracture assessment (including fall risk), care coordination and collaboration, diagnosis, treatment planning, treatment initiation and follow-up care.

Almost 2 million Medicare beneficiaries suffered osteoporotic fractures in 2016, which are a major driver of opioid dependency and nursing-home admissions. Projections suggest the problem will rise as the U.S. population ages. In 2018, the total cost of providing care for osteoporotic fractures was approximately $57 billion. By 2040, it is estimated there will be a 68% increase in osteoporotic fractures, with costs exceeding $95 billion. A care-coordination payment mechanism would im prove care for Medicare beneficiaries who suffer osteo porotic fractures every year and would help to address the rate of expected growth in such fractures, repeated fracture patterns, as well as long-term opioid use and associated risk of addiction. The physician and provider letter comes on the heels of a letter to CMS from 12 national physician and patient advocacy organizations and a letter to CMS from 19 ma jor women’s health, aging and patient orgs requesting the same policy changes.

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