Medicare's 2025 PFS Rule to Enhance Post-Fracture Care

Posted by John, Volunteer Mentor @johnbishop, Jul 23 8:31am

I thought I would share this recent news from the National Bone Health Policy Institute (BHOF) - https://www.bonehealthandosteoporosis.org/
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We are excited to share a significant development in the fight against osteoporosis. The Centers for Medicare and Medicaid Services (CMS) have released the proposed 2025 Medicare Physician Fee Schedule (PFS) rule, which takes crucial steps to improve post-fracture care for osteoporosis patients in the U.S.

Key Highlights of the Proposed Rule:
-- New Coding for Fracture Management: The proposed rule introduces new coding options that enable better management of fractures under comprehensive treatment plans. This includes the global post-operative add-on code (HCPCS code GPOC1) and advanced primary care management codes.

-- Enhanced Reimbursement: By recognizing the additional efforts required for post-fracture care, the rule aims to ensure that providers are adequately reimbursed for the comprehensive care they deliver, improving patient outcomes and reducing the risk of subsequent fractures.

-- Focus on Evidence-Based Care: CMS is seeking public comments to understand the frequency and barriers to providing evidence-based care for fracture patients. This initiative is expected to address the gaps in care and ensure that more patients receive the treatment they need.

We at the Bone Health and Osteoporosis Foundation (BHOF) have been at the forefront of advocating for these changes. We are so grateful to those of you who have called on and written to your Members of Congress regarding this matter. Our collective efforts with a coalition of patient advocacy and health professional organizations have been instrumental in bringing this issue to the attention of CMS. We will continue to work closely with CMS and other stakeholders to ensure that the final rule includes provisions that will make quality post-fracture care the standard.

Your support is crucial in ensuring that these proposed changes are implemented and that all osteoporosis patients receive the care they deserve.

For more information, please view the press release below.
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-- Medicare’s Proposed 2025 PFS Rule Takes Critical First Steps to Improve Post-Fracture Care for Osteoporosis Patients in the U.S.: https://www.bonehealthandosteoporosis.org/news/medicares-proposed-2025-pfs-rule-takes-critical-first-steps-to-improve-post-fracture-care-for-osteoporosis-patients-in-the-us/

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

As a person with 7 spinal fractures, I have no idea what this actually means. I had no help whatsoever after fracturing, either time, and PT's don't know how to help fracture patients. Pain management programs with PT, OT and behavioral help are too expensive on Medicare Advantage. Drugs are too expensive for many. I was told there is no new treatment in the pipeline. Doctors don't seem to know what to do long term. I hope this actually does mean something.

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I am newly diagnosed with osteoporosis and have been started on monthly injections of Evenity. Nothing was explained to me about Evenity...good or bad.

I have other medical problems that specialists are treating.
I am on a multitude of
medications. I am always having to check the benefits of a new medication and any adverse effects it might have on me. I always have to be aware of any contra-
indications to any of my other medications.

It has made me be aware that I have to be my own advocate for my health.

REPLY
@pam6426

I am newly diagnosed with osteoporosis and have been started on monthly injections of Evenity. Nothing was explained to me about Evenity...good or bad.

I have other medical problems that specialists are treating.
I am on a multitude of
medications. I am always having to check the benefits of a new medication and any adverse effects it might have on me. I always have to be aware of any contra-
indications to any of my other medications.

It has made me be aware that I have to be my own advocate for my health.

Jump to this post

I was put on Prolia without any mention of rebound effects when going off it or anything else. I suffered terrible reactions from it. Aching joints, bleeding swollen gums and hair loss just to mention a few side effects. I am now on actonel once a week which I have been tolerating. My osteoporosis readings aren't horrible -I exercise vigorously - have a high vitamin d content in my body and have a lot of natural calcium in my diet. The doctors scare you about falling and dying within a year of fracture. However the side effects of these medications are bad. You are correct you have to be your own health care advocate.

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