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Osteostrong and Medicare Coverage

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1. Introduction

Osteoporosis is a disease that causes bones to become thin and weak, usually resulting in fractures after minimal trauma. Fractures caused by osteoporosis can be a serious health issue; this is because most of these fractures occur in the spine or hips. A hip fracture usually requires hospitalization, may be a long-term disability, and even lead to death. Spinal or vertebral fractures also have serious consequences, including severe back pain, loss of height, and deformity. Often, people who have had a vertebral fracture will have another. It is a common fact among patients with osteoporosis, especially postmenopausal women, that they have a heightened number of fractures that can be decreased by preventing the fragility of their bones. Thus, a goal in treating osteoporosis is to decrease the chance of a fracture. Medications approved by the US FDA are available to effectively prevent and treat osteoporosis. OsteoStrong is a 4-modality physical medicine using bone density scanning, impact emulation, and postural alignment. Progressive resistance is used to attain effects in these 4 categories. The cited effects were reversed and/or strengthened bone density in 100% of cases, lowered and/or normalized TRP markers in 100% of cases, and improved and/or corrected posture in 95%. There are no specific contraindicating conditions, as adaptive resistance is used to tailor the treatment to the individual. There are many different medications and regimens that can be used to treat osteoporosis, often making it difficult to find the right method. In order to give a better understanding of how Medicare covers osteoporosis, I have broken down the general information into several subtopics.

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2. What is Osteostrong?

OsteoStrong is a non-pharmaceutical medical solution that focuses on boosting skeletal strength and building strong bones. It is the natural way to trigger the growth of bone density. The sessions are quick and painless, each of them known as osseous loading. Over the course of the session, you will be putting force onto various machines. Each machine has been programmed with robotics to know the exact force you can handle – this will give the best results. The force itself will be converted to your body weight to create a brief impact to safely signal growth in bone. Coaching is also an essential part of OsteoStrong. Members are being educated on their skeletal and bone health. This is to ensure they are reaching maximum efficiency with each session and providing knowledge of how OsteoStrong is affecting the growth of their bones. OsteoStrong is safe for all ages and is also a solution for athletic performance. With stronger bones, there will be a significant increase in sport function and many have seen a decrease in recovery time from an injury. OsteoStrong is a solution to take out the concern of bone density acquisition and or an alternative to increase strong bone growth. With your commitment, OsteoStrong can lead the way to a stronger, healthier lifestyle.

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3. Medicare Coverage for Osteostrong

Osteoporosis is a devastating and prevalent disease. It has been predicted that by 2020 over 61 million Americans will have either osteoporosis or low bone mass. An estimated 10 million individuals already have the disease, and 34 million more have low bone mass, which places them at higher risk for the disease. Osteoporosis is often regarded as an older person’s disease, but it is not exclusive to them. Osteoporosis and low bone mass are a major public health threat for 44 million U.S. women and men aged 50 and older. Both the disease and broken bones are a cause of major disability and loss of independence.

This is important because in 2008 the cost of a fracture to the Medicare program was estimated to be $18 billion and increases as baby boomers age and more individuals are afflicted with osteoporosis. Under the Affordable Care Act, this preventive service is covered at no cost to those already with Medicare, and a yearly wellness visit can help develop or update a personalized prevention plan.

As a fledgling worldwide company still in the midst of a major expansion, OsteoStrong is taking a grassroots approach to attempting to have sessions covered under health savings accounts and flexible spending accounts. Sessions at OsteoStrong are already covered by some private insurers. Osteoporosis is a silent disease. You cannot feel your bones becoming weaker. Since a bone density scan is the only way to diagnose osteoporosis early and determine your risk of fracture, it is deserving that Medicare Part B covers the exam for those with an increased risk of osteoporosis and every 24 months for those at risk.

Medicare is U.S. government health insurance that covers seniors age 65 and older and has established coverage for a variety of treatments, therapies, and devices for osteoporosis. However, Medicare does not currently cover treatment at OsteoStrong. This discrepancy is because the cost of enrolling OsteoStrong in Medicare coverage outweighs the profit for OsteoStrong since a major portion of OsteoStrong’s cost is made up of the machines. These machines are of great importance and a substantial investment because they were designed specifically by OsteoStrong founder John Jaquish to biohack the body’s natural bone and muscle growth processes.

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4. Eligibility Requirements

According to the Social Security Administration, there are various ways to become eligible for Medicare insurance. One way is being over the age of 65 and likely either receiving Social Security benefits or retirement benefits from the Railroad Retirement Board. A second way is being eligible to receive Social Security disability benefits or benefits from the RRB for 24 months. A third way is having End-Stage Renal Disease (ESRD), defined as permanent kidney failure requiring a transplant or dialysis. It is important to remember that under the Affordable Care Act, Medicare eligibility is no longer based on having ESRD. An individual can also become eligible for Medicare insurance if they have been diagnosed with Lou Gehrig’s Disease and will receive Social Security disability benefits. [1][2][3][4][5][6][7][8]

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5. Conclusion

Given their favorable long-term side effect profile, biochemical markers of bone turnover are the most likely functional indicators to be of benefit in monitoring patients in the future. However, with their relative newness and further development to make them more cost effective, it may be a little while before they are used in this way. The recent development of effective “antiresorptive” agents has highlighted the fact that postmenopausal and glucocorticoid-induced osteoporosis are now treatable and in many cases, preventable diseases. Further research in this area as well as increased awareness of the potential economic benefits to society could help to shift the perception of osteoporosis from an unpreventable degenerative disease to a treatable condition with a focus on maintenance of bone strength and quality.

Pieces of work have clearly shown the importance of considering potential methods to reduce the burden of this prevalent disease. Our modeling suggests that there are potential economic benefits to society from appropriate public and private investment in the prevention and treatment of osteoporosis. Although there are still some uncertainties associated with this modeling, our findings indicate that it is of great importance to further investigate the health care utilization of patients with osteoporosis as well as the cost effectiveness of new and existing treatments. An effective and suitable prevention and treatment strategy for osteoporosis would not only improve the lives of the sufferers but would also reduce the economic burden of this disease on society.

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References:

[1] V. Wang, L. Zepel, B.G. Hammill, A. Hoffman, et al., “Rates of medicare enrollment among dialysis patients after implementation of medicare payment reform and the affordable care act marketplace,” JAMA Network Open, vol. 2022, jamanetwork.com, 2022. jamanetwork.com

[2] K. H. Nguyen, E. G. Oh, D. J. Meyers, D. Kim, R. Mehrotra, “Medicare Advantage enrollment among beneficiaries with end-stage renal disease in the first year of the 21st Century Cures Act,” JAMA, vol. 2024. [Online]. Available: jamanetwork.com. nih.gov

[3] A. Hoffman, C. E. Sloan, M. L. Maciejewski, and V. Wang, “Medicare enrollment among patients with end-stage kidney disease receiving dialysis in outpatient facilities between 2005 and 2016,” JAMA, 2020. jamanetwork.com

[4] R. Thorsness and A. N. Trivedi, “The dialysis safety net: who cares for those without Medicare?” Journal of the American Society of Nephrology, 2020. [Online]. Available: journals.lww.com. nih.gov

[5] G. Marrufo, E. M. Colligan, B. Negrusa, et al., “Association of the comprehensive end-stage renal disease care model with medicare payments and quality of care for beneficiaries with end-stage renal disease,” JAMA Intern. Med., vol. 180, no. 6, pp. 848-856, 2020. jamanetwork.com

[6] M. L. Mendu and D. E. Weiner, “Health policy and kidney care in the United States: core curriculum 2020,” American Journal of Kidney Diseases, 2020. ajkd.org

[7] E. G. Oh, D. J. Meyers, K. H. Nguyen, and A. N. Trivedi, “… Dialysis Networks In Medicare Advantage: Exposure By Race, Ethnicity, And Dual Eligibility: Study examines dialysis networks in Medicare Advantage across race …,” Health Affairs, 2024. nih.gov

[8] O. Salichs, S. Doddi, T. Hibshman, J. Hersi et al., “Understanding Renal Failure Mortality Trends and Determinants in the US (1999–2020): Impacts of the Affordable Care Act, Advancements, Disparities, and …,” Uro, 2024. mdpi.com

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