Medicare Spends More Than $6 Billion on Secondary Fractures

Medicare could save billions of dollars if secondary fractures could be prevented with improved osteoporosis screening.

HealthDay News — Medicare could save billions of dollars if secondary fractures could be prevented with improved osteoporosis screening, according to a new National Osteoporosis Foundation report conducted by Milliman.

Milliman used administrative medical claims data from a Medicare Limited Data Set to identify new osteoporotic fractures not associated with a high-trauma event among Medicare fee-for-service beneficiaries in 2015. The postfracture follow-up period to assess the economic and clinical burden associated with fractures lasted two to three years.

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The researchers found that about 4 percent of Medicare beneficiaries suffered a fracture in 2015. Spine and hip fractures were the most common types identified, accounting for 40 percent of all osteoporotic fractures. More than 40 percent of patients with a new osteoporotic fracture were hospitalized within one week after the fracture (among those with a hip fracture, 90 percent were hospitalized). More than one in seven Medicare patients with a new osteoporotic fracture suffered another fracture within 12 months of the initial fracture, and nearly one in five with a new osteoporotic fracture developed a pressure ulcer during follow-up. One in five Medicare beneficiaries died within 12 months following a new osteoporotic fracture. In the year after a new osteoporotic fracture, medical costs were more than twice the costs incurred in the 12-month period prior to the fracture for the same beneficiary, yielding an incremental annual medical cost of $21,800 for a new osteoporotic fracture. An estimated 307,000 Medicare fee-for-service beneficiaries had a subsequent fracture during two- to three-year follow-up, which the researchers estimated accounted for $6.3 billion in allowed cost to Medicare. Fewer than one in 10 female Medicare beneficiaries were evaluated for osteoporosis with a bone mineral density test within six months of a new fracture.

“Increased focus on the identification and management of individuals who have experienced an osteoporotic fracture through a secondary fracture prevention program may lead to reduced rates of subsequent fractures and result in cost savings to payers, such as Medicare,” the authors write.

Research Report: Medicare Cost of Osteoporotic Fractures