Associations between the 2007 Medicare reimbursement reduction for bone mineral density testing and osteoporosis drug therapy patterns of female Medicare beneficiaries

Abstract

Sun Jung Kim,1,2 Joo Hun Lee,3 Sulgi Kim,4 Shunichi Nakagawa,5 Heather Bertelson,6 Julia Lam,7 Ji Won Yoo6,7 1Department of Public Health, 2Institute of Health Services Research, Yonsei University College of Medicine, 3Department of Media and Communication, Hanyang University College of Social Sciences, Seoul, Republic of Korea; 4Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA; 5Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA; 6Department of Internal Medicine, Aurora Health Care, Milwaukee, WI, USA; 7Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA Objective: To examine how drug therapy patterns for osteoporosis have changed after the Medicare Physician Fee Schedule (MPFS) reimbursement reduction in 2007, in relation to follow-up bone mineral density (BMD) testing status. Methods: We used a retrospective temporal shift design to examine changes in drug therapy patterns before (Phase 1: January 1, 2005–December 31, 2006) and after (Phase 2: July 1, 2007–June 30, 2009) the MPFS reimbursement reduction in 2007, Cleveland, OH, USA. Participants were osteoporotic older women in Phase 1 (n=1,340) and Phase 2 (n=1,437). The main outcomes were a) adherence, b) adjustment, c) occurrence of an extended gap, and d) restarting drug therapy after an extended gap. Follow-up BMD testing status by study phase and location were also analyzed. Results: BMD testing rates at physicians’ offices decreased from 64.5% in Phase 1 to 58.4% in Phase 2 (P=0.02); however, testing rates in hospital outpatient settings increased (from 20.8% to 24.5%). There were also decreases in drug therapy adjustment from 15.9% in Phase 1 to 11.6% in Phase 2 (odds ratio [OR]: 0.73; P<0.01) and in restarting drug therapy after an extended gap (55.4% in Phase 1 and 43.6% in Phase 2; OR: 0.76; P<0.01). Conclusion: There were no changes in the overall rate of follow-up BMD testing. The rates of drug adjustments and restarting drug therapy after an extended gap did decrease. These decreases were more evident when follow-up BMD testing was not performed. Keywords: accessibility of health services, drug therapy, osteoporosis, elderly women