AOA Own the Bone ® INSERT YOUR SITE NAME HERE

1. AOA Own the Bone®INSERT YOUR SITE NAME HERE

2. Welcome Goals of Meeting Discuss osteoporosis and low bone density Learn about the AOA Own the Bone® Program Identify and Initiate Implementation Steps for Own the Bone Welcome/Goals 2

3. Osteoporosis/Low Bone DensityMagnitude of Problem 3 • Nearly 25% of patients who suffer a hip fracture die within 12 months, while another 20% end up in a nursing home • Fragility is the most common cause of fractures among seniors, yet only 20% of patients receive best-practice care • Up to 50% of all women and 25% of all men over age 50 will sustain fragility fractures in their remaining lifetime

4. Fragility Fracture Occurrences • Fractures cost: >$19 billion/year • Increase expected if no action 400,000wrist 550,000 vertebral 350,000 hip 125,000 pelvic 675,000 other Sources: American Cancer Society . Cancer Facts & Figures 2010. Atlanta: American Cancer Society; 2010. Heart Disease and Stroke Statistics — 2011 Update, American Heart Association. JOURNAL OF BONE AND MINERAL RESEARCH, Volume 22, Number 3, 2007 Published online on December 4, 2006; doi: 10.1359/JBMR.061113

5. Why Did AOA Create Own the Bone® ? 5 • AOA Critical Issue: AOA understood it would take leadership to change physician and patient behavior • AOA developed Own the Bone to address a treatment gap highlighted in the 2004 U.S. Surgeon General’s Report on Bone Health and Osteoporosis • AOA successfully piloted Own the Bone in 14 hospitals in the United States for 10 months in 2005/2006 • Results published in JBJS January 2008

6. What isOwn the Bone® ? 6 • A web-based quality improvement initiative • Multi-specialty approach • A means to identify, evaluate and initiate evidence-based care for osteoporosis and low bone density after a fragility fracture in patients aged 50 and over • Follows National Osteoporosis Foundation Clinician’s Guidelines • Overlaps with CMS, AMA Physician’s Consortium, HEDIS Measures • Consistent with Joint Commission Monograph on Osteoporosis

7. Own the Bone®: Goals 7 • Increase overall awareness and improve utilization of evidence-based management of osteoporosis and low bone density in fragility fracture patients 50 and over • Change physician and patient behavior to reduce the incidence of future fractures and improve patient care by promoting bone health • Encourage clinicians to identify, evaluate, diagnose, and treat patients with poor bone health after a fragility fracture • Close the “treatment gap” documented in theRAND and NCQA studies • Capitalize on the “Teachable Moment”

8. Own the Bone®: Benefits 8 • Promotes gathering and recording of pertinent information efficiently through a national, web-based registry • Access to a downloadable library of patient education tools to assist in compliance with 10 evidence-based measures • System-generated patient and physician letters detailing the patient’s risk factors and recommendations for better bone health • Benchmarking reports allows us to compare our results against the aggregate results of all Own the Bone participants • E-Newsletters

9. Own the Bone® : Benefits 9 • Web-based training • Registry webinar trainings held every other month • Registry training videos available at ownthebone.org for subscribers • Exchange of best practices among participants through ongoing webinars • 40% Discount on National Osteoporosis Foundation patient education materials • Public relations tools • Press Release templates • Special Own the Bone Participant Logo

10. Why enroll in Own the Bone®? • Improve patient care • - It’s the right thing to do! • Positive public relations • - Quality documentation and benchmarking with other facilities • - Increase patient volume - “center of bone health excellence” • Preparation for Healthcare Reform and future regulatory requirements • - CMS, PQRS, Joint Commission • Liability concerns • - Avoid lawsuits due to “failure to diagnose and treat” after a fracture

11. The Program Measures Nutrition Counseling* • Calcium supplementation • Vitamin D supplementation Physical Activity Counseling* • Weight-bearing and muscle strengthening exercise • Fall prevention education Lifestyle Counseling* • Smoking cessation (if needed) • Limiting excessive alcohol intake *Unless contraindicated Measures listed here are consistent with recommendations from the National Osteoporosis Foundation, the Centers for Medicare & Medicaid Services, the Joint Commission, the World Health Organization, and the American Medical Association.

12. The Program Measures Diagnostic Testing* • Dual Energy X-Ray Absorptiometry (DXA) to test bone mineral density Pharmacology* • Pharmacology for the treatment of osteoporosis • Multiple options Communication* • Letter and educational material to patient • Letter to Primary Care Physician *Unless contraindicated Measures listed here are consistent with recommendations from the National Osteoporosis Foundation, the Centers for Medicare & Medicaid Services, the Joint Commission, the World Health Organization, and the American Medical Association.

13. Own the Bone®Case Report Forms Simple Case Report Forms facilitates data management

14. Own the Bone® Web-based Data Registry 14 Simple, Web-based registry facilitates data management Property of American Orthopaedic Association (AOA)

15. Collect data Enter and manage the data Provide patient education materials (downloadable from the registry) Communicate with Physician and Patient through system-generated letters Refer or schedule for DXA or pharmacotherapy, when indicated Follow up at 90 days (optional) Implementation 15

16. Define trigger system to identify patients Who do we treat? Hip fracture patients? Other? Determine protocol to screen and treat patients Define lab panels Order osteoporosis consult Schedule DXA Assign roles to team members Who identifies eligible patients? Who counsels patients? Who does data entry? Implementation: Questions to Consider 16

17. Review www.ownthebone.org website and Getting Started/Subscriber’s binder Define trigger system to identify patients Determine protocol to screen and treat patients Assign roles to team members Set next meeting Timeline 17

18. Resources • Getting Started Binder Program protocol Best practices Case Report Form National Osteoporosis Foundation – A Reference Guide for Osteoporosis Reimbursement Policy for Healthcare Professionals • Visit www.ownthebone.org for more materials Training Webinars More best practices • Contact Own the Bone staff Phone: 847-318-7336 E-mail: ownthebone@aoassn.org

19. AOA Contact Information: www.ownthebone.org ownthebone@aoassn.org Phone: 847.318.7336 Fax: 847.318.7339 AOA Own the Bone® Team 19