title: Associations between the 2007 Medicare reimbursement reduction for bone mineral density testing and osteoporosis drug therapy patterns of female Medicare beneficiaries.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health, Yonsei University College of Medicine, Seoul, Republic of Korea ; Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sun Jung
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Media and Communication, Hanyang University College of Social Sciences, Seoul, Republic of Korea.
authors.forename: Joo Hun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Sulgi
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Nakagawa
authors.affiliation: Department of Internal Medicine, Aurora Health Care, Milwaukee, WI, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Bertelson
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Lam
authors.affiliation: Department of Internal Medicine, Aurora Health Care, Milwaukee, WI, USA ; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Yoo
keywords: accessibility of health services; drug therapy; elderly women; osteoporosis