FLS BUSINESS PLANS

Establishment of a clinically- and cost-effective Fracture Liaison Service (FLS) that is sustainable will requires development of a comprehensive FLS business plan, which includes the demonstration of the economic impact of a FLS for the particular organization. 

Following is a generic, downloadable FLS business plan template and companion slide deck to support leaders who are developing FLS programs build a FLS program case for support:

FLS RETURN ON INVESTMENT CALCULATOR

We are pleased to provide you with our interactive FLS return on investment calculator to help you estimate the economic benefit of implementing a secondary fracture prevention FLS program. Through grants, the Research Triangle Institute and the University of Alabama-Birmingham, have developed an interactive FLS return on investment calculator to help you estimate the economic benefit of implementing a secondary fracture prevention program. This calculator enables FLS champions to make the business case for FLS implementation by inputting their own data on the estimated costs to implement FLS, revenue generated from FLS services and the projected impact on refracture rates and fracture cost savings. We thank Arnie Aldridge and William Dowd (Research Triangle Institute) and Dr. Lang Chen and Dr. Jeffrey Curtis (University of Alabama-Birmingham) for their work in developing the FLS calculator.

Quality Measures

Fracture Liaison Service programs can improve compliance with a number of quality measures related to osteoporosis and post-fracture care. As quality measures transition from payment incentives to penalties, and from process to outcomes, adopting the FLS model of care can help institutions reduce healthcare costs in the short term and avoid penalties in the long term. 

Medicare Advantage’s Five-Star Quality Rating System currently includes one osteoporosis process measure: Osteoporosis management in women who had a fracture. The State of Health Care Quality 2012 report from the National Committee for Quality Assurance (NCQA) provides data on this Healthcare Effectiveness Data and Information Set (HEDIS®) osteoporosis measure.

  • In 2011, among female Medicare beneficiaries age 67 years and older, the proportion who had either a bone mineral density test or prescription for a drug to treat or prevent osteoporosis in the six months after the fracture was 22.8% (HMO) and 19.3% (PPO). These data show little change compared to 2007 at 20.4% (HMO) and 17.8% (PPO).

Note that quality scores for Medicare Advantage plans are based on performance measures derived from plan and beneficiary information collected in three surveys – the NCQA HEDIS®, the Agency for Healthcare Research and Quality Consumer Assessment of Healthcare Providers and Systems (CAHPS), and the Medicare Health Outcomes Survey (HOS) – as well as administrative data. An additional HEDIS® primary osteoporosis screening measure, Osteoporosis testing in older women, assesses the percentage of Medicare women age 65 and older who report ever having received a bone density test to check for osteoporosis.

  • In 2011, adherence to this measure was 75% in Medicare PPO plans and 71% in Medicare HMO plans.

Given that the osteoporosis management after fracture HEDIS® measure is one where consistently low performers do poorest, a focus on osteoporosis care through the implementation of a FLS program is an opportunity to improve a health plan’s Medicare Advantage quality rating. Additionally, beginning in 2013, hospitals faced penalties equal to 1% of their total Medicare billings if an excessive number of patients are readmitted (this penalty rose to 2% in 2014 and will be 3% in 2015). Hip fractures were the cause of 14.5% of all 30-day readmissions in 2009 (nearly unchanged from the 14.3% rate in 2004). Further, several Centers for Medicare and Medicaid Services (CMS) Medicare Physician Quality Reporting System (PQRS) measures focus on osteoporosis care, including:

  • Osteoporosis: Communication with the Physician Managing Ongoing Care Post-Fracture of Hip, Spine or Distal Radius for Men and Women Aged 50 Years and Older (measure #24);

  • Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older (measure #39);

  • Osteoporosis: Management Following Fracture of Hip, Spine or Distal Radius for Men and Women Aged 50 Years and Older (measure #40);

  • Osteoporosis: Pharmacologic Therapy for Men and Women Aged 50 Years and Older (measure #41);

  • Falls: Risk Assessment (measure #154); and

  • Falls: Plan of Care (measure #155)