Making post-fracture follow-up care a priority.
Posted 04/25/25
Promote bone density scans & osteoporosis medications when appropriate
Did you know that only 20% of patients who experience a hip fracture are prescribed medications proven to significantly reduce the risk of a second fracture, while 95% of patients who experience a heart attack are prescribed medications to prevent another heart attack?1 This statistic is particularly troubling, as unidentified or untreated osteoporosis can result in additional fractures which can be painful, costly, decrease patients’ quality of life, or even result in death.
In fact, the challenges with post-fracture care are so prevalent that the problem was addressed as part of Medicare’s Proposed 2025 Physician Fee Schedule (PFS) rule. The rule indicates a two-fold issue affecting appropriate post-fracture care:
- There is a disconnect as to which provider has ownership of osteoporosis diagnosis and treatment following fracture.
- There is more focus on acute fracture recovery than osteoporosis diagnosis and treatment.
CMS is now proposing new billing codes for managing fractures under a treatment plan to incentivize providers to provide this care.
In addition, the NCQA HEDIS® measure—Osteoporosis Management in Women Who Have Had a Fracture—promotes appropriate post-fracture care, monitoring the frequency that women 67–85 years of age who experience a fracture have a bone density scan or are prescribed a drug to treat osteoporosis within six months of the fracture event. (Women are excluded if they have had a bone density test within two years of the fracture event.)
At Martin’s Point, we continue to support our members in this effort by notifying provider offices of members with recent fractures and inquiring about the appropriateness of a bone density screening. We also encourage these members to discuss bone density scans with their providers. We hope you can support our goal of ordering bone density scans or osteoporosis medications, as appropriate, to help prevent future fractures and promote the best health of our members/your patients.
