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

摘要

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.