Abstract
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.
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Acknowledgments
All authors confirm that all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story. This manuscript has not been under review or has not been published elsewhere. The authors thank Ms Susan Garcia, who helped prepare the manuscript, and Ms Brenda Fay for the literature search.
Disclosure
This study is supported by the American Geriatrics Society (Junior Researcher Seed Grant) and the Korean Ministry of Education, Science, and Technology (Excellence of Quality of Care Project). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The authors report no conflicts of interest in this work.