Medicare Fee For Service Research Articles

Abstract No. 574 Intracranial arterial mechanical thrombectomy in the United States: recent trends in utilization and physician specialty in fee-for service Medicare claims

Abstract No. 574 Intracranial arterial mechanical thrombectomy in the United States: recent trends in utilization and physician specialty in fee-for service Medicare claims

Abdominal aortic calcification (AAC) and ankle-brachial index (ABI) predict health care costs and utilization in older men, independent of prevalent clinical cardiovascular disease and each other

Background and aimsAbdominal aortic calcification (AAC) and low ankle-brachial index (ABI) are markers of multisite atherosclerosis. We sought to estimate their associations in older men with health care costs and utilization adjusted for each other, and after accounting for CVD risk factors and prevalent CVD diagnoses. MethodsThis was an observational cohort study of 2393 community-dwelling men (mean age 73.6 years) enrolled in the Osteoporotic Fractures in Men (MrOS) study and U.S. Medicare Fee for Service (FFS). AAC was scored on baseline lateral lumbar spine X-rays using a 24-point scale. ABI was measured as the lowest ratio of arm to right or left ankle blood pressure. Health care costs, hospital stays, and SNF stays were identified from Medicare FFS claims over 36 months following the baseline visit. ResultsMen with AAC score ≥9 (n = 519 [21.7% of analytic cohort]) had higher annualized total health care costs of $1473 (95% C.I. 293, 2654, 2017 U S. dollars) compared to those with AAC score 0–1, after multivariable adjustment. Men with ABI <0.90 (n = 154 [6.4% of analytic cohort]) had higher annualized total health care costs of $2705 (95% CI 634, 4776) compared to men with normal ABI (≥0.9 and < 1.4), after multivariable adjustment. ConclusionsHigh levels of AAC and low ABI in older men are associated with higher subsequent health care costs, after accounting for clinical CVD risk factors, prevalent CVD diagnoses, and each other. Further investigations of whether preventing progression of peripheral vascular disease and calcification reduces subsequent health care costs are warranted.

Quantifying the impact of changing the threshold of New York City heat emergency plan in reducing heat-related illnesses

The adverse health impact of high heat is widely documented and can lead to a substantial public health burden. Although heat-related illness in western countries is largely preventable, extreme heat remains the main weather contributor to the burden of disease in the United States. In most US cities, local National Weather Service offices issue heat alerts in advance of forecast periods of high heat. In some locations, additional local heat emergency plans that include additional community-based actions to protect the public from the health impacts of heat are also triggered. In 2008, the NYC Health Department made changes in their local heat emergency plan by lowering the threshold for triggering heat advisories based on evidence from local epidemiological studies. This study aims to quantify the potential benefits associated with the change in the threshold the NYC Heat Emergency Plan in reducing heat-related illnesses for Medicare fee-for service beneficiaries aged 65 years or older. We apply a quasi-experimental study design using the Difference-in-Differences (DID) method coupled with the propensity-score matching and compare the difference in daily rates of heat-related illnesses between eligible and non-eligible days before and after implementing the threshold change (2006–2007 versus 2009–2010). We reveal that the change in threshold for the NYC Heat Emergency Plan is associated with reduced daily number of 0.80 (95%CI: 0.27; 1.33) Heat-related Illnesses during hot days as compared to a counterfactual scenario in which the original threshold did not change. This highlights the benefits of local epidemiological evidence in informing emergency heat action plans, in decreasing the health burden of high ambient heat.

LDL-C Values and Lipid Lowering Therapy Utilization in a Medicare Fee For Service (FFS) Population

Research and consulting: Amgen Inc., Boehringer Ingelheim, Cytokinetics, Relypsa.

THE HEALTHCARE BURDEN OF DISEASE PROGRESSION IN MEDICARE PATIENTS WITH FUNCTIONAL MITRAL REGURGITATION

This retrospective database analysis estimates the incremental effect that disease progression from non-clinically significant functional mitral regurgitation (nsFMR) to clinically significant FMR (sFMR) has on clinical outcomes and costs. This analysis examined Medicare Fee for Service

3377 A cross-sectional analysis of opioid prescribing patterns among gynecologic oncologists using Medicare fee-for service provider utilization &amp; payment data

OBJECTIVES/SPECIFIC AIMS: Opioids are the first-line treatment for moderate to severe cancer-related pain. Increased awareness of opioid prescription misuse and adverse outcomes has prompted statements on their use from multiple national medical groups. In this study we characterize national-level opioid prescription patterns among gynecologic oncologists treating Medicare beneficiaries. METHODS/STUDY POPULATION: The Centers for Medicare and Medicaid Services (CMS) database was used to access Medicare Part D beneficiary data (2016). All available opioid claims prescribed by gynecologic oncologists were identified. Medication type, prescription length and other prescribing factors were recorded. Physician demographics were obtained from departmental websites and accrediting bodies. Physicians with &lt;10 opioid claims are not included in the CMS database. Bivariate statistical analysis including chi-squared, Fisher’s exact test and Wilcoxon rank-sum test were performed to compare variables with threshold for significance set at p&lt;0.05. Linear regression modeling was also performed to examine association of gender with number of opioids prescribed. RESULTS/ANTICIPATED RESULTS: A total of 494 board-certified gynecologic oncologists were included in this analysis. In 2016, gynecologic oncologists wrote 23,584 opioid prescriptions for 267,824 days of treatment (average of 9.24 prescribed days per claim). The most commonly prescribed opioid was oxycodone/acetaminophen (41%). Male physicians had significantly more opioid prescription claims than females (p&lt;0.01) including after adjusting for differences in years of experience. The majority of physicians had 11-50 opioid prescription claims (68%). A minority were high prescribing physicians with &gt;100 opioid claims (11%). Of these, the overwhelming majority were male (82%) and late career (46%, &gt;15 years since board certification). Physicians in the South had the greatest number of opioid prescription claims and significantly more than physicians in the Northeast, who had the fewest (p&lt;0.01). Mean number of opioid claims increased with increasing years of experience (p&lt;0.05). DISCUSSION/SIGNIFICANCE OF IMPACT: Among gynecologic oncologists, there were gender-based, regional and experience-related variations in opioid prescribing in the Medicare population in 2016. Further longitudinal studies are required to elucidate secular trends in opioid prescription practice.

Outcomes after thoracic endovascular aortic repair in patients with chronic kidney disease in the Medicare population

ObjectiveThoracic endovascular aortic repair has been increasingly performed in higher-risk patients with renal failure. The objective was to compare Medicare patients with preoperative chronic kidney disease with patients with normal renal function to determine differences in postoperative survival and complications. MethodsFrom 2000 to 2014, 27,079 Medicare fee-for service patients underwent thoracic endovascular aortic repair. Patients were stratified by kidney function, and 23,375 patients (86%) had no chronic kidney disease, 2957 patients (11%) had chronic kidney disease stage I/IV, and 747 patients (3%) had end-stage renal disease or hemodialysis. Groups were then compared with determined differences in adjusted all-cause mortality and rates of postoperative complications. ResultsOverall survival was significantly worse among patients with chronic kidney disease and end-stage renal disease or hemodialysis compared with patients with no chronic kidney disease (1-year survival no chronic kidney disease: 78%; chronic kidney disease I/II: 77%; chronic kidney disease III: 67%; chronic kidney disease IV: 58%; and end-stage renal disease or hemodialysis: 48%, P < .001). Mortality was significantly increased among patients with chronic kidney disease III (hazard ratio [HR], 1.29; P < .001), chronic kidney disease IV (HR, 1.74; P < .001), and end-stage renal disease or hemodialysis (HR, 2.03; P < .001). No mortality difference was found between patients with no chronic kidney disease and patients with chronic kidney disease stage I/II. At 30 days after thoracic endovascular aortic repair, sepsis was increased for patients with chronic kidney disease stage III/IV (HR, 1.7; P < .001) and end-stage renal disease or hemodialysis (HR, 2.7; P < .001). ConclusionsIn this elderly Medicare population undergoing thoracic endovascular aortic repair, patients with chronic kidney disease stage III, chronic kidney disease stage IV, or end-stage renal disease/hemodialysis had poor survival and increased morbidity compared with those with normal kidney function. These data may suggest that patients with chronic kidney disease stage III, chronic kidney disease stage IV, or end-stage renal disease/hemodialysis should be more cautiously evaluated for thoracic endovascular aortic repair, weighing the benefits of the procedure against the high expected mortality.

Abstract TP277: A Hospital’s Perspective: Economic Evaluation of Hospitalization vs Rapid Outpatient Evaluation for TIA and Minor Strokes

Introduction: Patients presenting to emergency departments (ED) with TIA and minor strokes (TIAMS) are often admitted for expedited evaluation, though outpatient care models have been proposed. We piloted a rapid outpatient evaluation protocol for patients presenting with TIAMS within 24 hours of ED discharge. We hypothesized that this approach would reduce hospital costs and length of stay (LOS). Methods: This analysis looked at patients presenting to our institution’s ED with TIAMS (NIHSS &lt; 5) in calendar year 2017. We compared hospitalization LOS, costs and expected revenues between admitted patients and those referred for rapid outpatient evaluation. Patients eligible for outpatient evaluation were without disabling deficits, recurrent symptoms, new-onset atrial fibrillation, prior carotid imaging with &gt;50% stenosis, and not receiving thrombolysis. Disabling deficits were defined as new gait impairments, significant motor weakness, hemianopia, dysphagia or severe aphasia. Cost data was obtained from our finance department and expected revenue was estimated using Medicare reimbursement data, assuming Medicare-Fee for Service as the primary payer for all patients. Results: We identified 92 patients referred to our rapid outpatient clinic and 90 admitted patients (mean NIHSS 0.8 vs 1.8 respectively). In comparison to patients who were admitted, patients referred to outpatient evaluation had shorter hospital stays, lower total hospitalization costs, and decreased net-losses after accounting for expected revenue (Table). Only one patient in the outpatient cohort was readmitted for further management. Overall, the one-year pilot cohort averted approximately 138 bed-days and $950,000 in hospitalization costs. Conclusions: For patients who presented to our ED with TIAMS without disabling deficits, rapid outpatient evaluation reduced hospital LOS and total costs. Further research is needed to incorporate costs to payers and patients.

Is self or caregiver report comparable to Medicare claims indicators of healthcare utilization after stroke?

Background: Claims data from Medicare or other payers might not generalize to other populations regarding service use after stroke especially among younger patients. However, high agreement between self-report and Medicare claims data would support the use of self-reported healthcare utilization data in these populations.Methods: A population-based sample of 147 stroke participants with traditional fee-for service Medicare and their family caregivers was examined. Concordance with Medicare claims was examined for stroke participant self-report for Emergency Room visits, hospitalizations, and physician visits for a six-month period after stroke, and for both stroke participant and caregiver reports of receipt of Physical Therapy (PT), Speech and Language Pathology (SLP), or Home Health Agency (HHA) visits.Results: Agreement was good for Emergency Room visits (kappa 0.75), hospitalization (kappa 0.70), and physician visits (Prevalence Adjusted Bias Adjusted Kappa [PABAK] 0.69) but more moderate for physical therapy, speech and language therapy, and home health agency visits (kappa 0.56–0.63). Caregiver agreement with Medicare claims was similar to stroke participant agreement. African Americans were less likely to self-report therapy compared to whites (OR 0.32 PT, 0.38 SLP, 0.29 HHA, p < 0.03). Younger stroke participants reported lower levels of Emergency Room visits than claims (OR 0.81, p = 0.001).Conclusion: Healthcare utilization after stroke can be reliably assessed from Medicare claims, Stroke participant, or Caregiver report for salient events such as hospitalizations and Emergency Room visits. Self-report and caregiver report appear to be less reliable for identifying use of therapy or home health services. Caution should be used when interpreting disparities based on self-report data alone in these areas.

Effects of Integrating Care for Medicare-Medicaid Dually Eligible Seniors in Minnesota

ABSTRACTIndividuals dually eligible for Medicare and Medicaid often receive fragmented and inefficient care. Using Minnesota fee-for-service claims, managed care encounters, and enrollment data for 2010–2012, we estimated the likely impact of Minnesota Senior Health Option (MSHO)—seen as the first statewide fully integrated Medicare-Medicaid model—on health care and long-term services and supports use, relative to Minnesota Senior Care Plus (MSC+), a Medicaid-only managed care plan with Medicare fee for service. Estimates suggest that MSHO enrollees had significantly higher use of primary care and, potentially, of community-based services, combined with lower use of hospital-based care than similar MSC+ enrollees. Adopting fully integrated care models like MSHO may have merit in other states.

Estimated Cost Savings: Everyone With Diabetes Counts (EDC) Program.

Everyone with Diabetes Counts (EDC) is a national disparities reduction program funded by the Centers for Medicare & Medicaid Services to improve outcomes in the underserved minority, diverse, and rural populations. This analysis evaluates West Virginia's pilot program of diabetes self-management education (DSME), one component of EDC. We frequency-matched 422 DSME completers to 1688 others by demographics and enrollment from Medicare fee-for service claims. We estimated savings associated with reduced hospitalizations in multivariable negative binomial models. DSME completers had 29% fewer hospitalizations (adjusted P < .0069). We estimated savings of $35 900 per 100 DSME completers in West Virginia.

Influenza vaccination coverage estimates in the fee-for service Medicare beneficiary population 2006 – 2016: Using population-based administrative data to support a geographic based near real-time tool

ABSTRACTOlder adults are at great risk of developing serious complications from seasonal influenza. We explore vaccination coverage estimates in the Medicare population through the use of administrative claims data and describe a tool designed to help shape outreach efforts and inform strategies to help raise influenza vaccination rates. This interactive mapping tool uses claims data to compare vaccination levels between geographic (i.e., state, county, zip code) and demographic (i.e., race, age) groups at different points in a season. Trends can also be compared across seasons. Utilization of this tool can assist key actors interested in prevention – medical groups, health plans, hospitals, and state and local public health authorities – in supporting strategies for reaching pools of unvaccinated beneficiaries where general national population estimates of coverage are less informative. Implementing evidence-based tools can be used to address persistent racial and ethnic disparities and prevent a substantial number of influenza cases and hospitalizations.

PRM11 - The Use of Real World Data to Define The Prevalence, Severity, and Etiology of Mitral Valve Regurgitation

Mitral regurgitation (MR) is a common valvular disorder, defined as degenerative (DMR) or functional (FMR), and is definitively diagnosed using imaging records. We established a series of expert rules based on clinical definitions to use claims data, which lacks clinical documentation and imaging results, to classify DMR, FMR, and a third uncharacterized cohort (UMR), to determine severity, and to account for ischemia. Patients with MR were defined by a minimum of 1 inpatient or 2 outpatient claims for MR. FMR was defined by the presence of heart failure (HF) during 6-months baseline, or 6-month post-diagnosis (washout); DMR was defined as either the presence of chordal rupture or absence of HF and ischemia; UMR was defined by patients otherwise not meeting criteria for FMR or DMR. MR was considered significant (sMR) if there was a prior MR surgery, a diagnosis of atrial fibrillation or pulmonary hypertension, or by serial echocardiograms (per clinical guidelines). Definitions were tested in 2 databases: (1) the Medicare Fee for Service (FFS) Standard Analytic Files and (2) the Medicare Advantage portion of the Medical Outcomes Research for Effectiveness and Economics Registry (MORE2). Patient distribution between the FFS and MORE2 are shown respectively by etiology: (FMR: 34%; 43%, DMR: 42%; 31%, and UMR: 24%; 26%) with consistent distributions for sMR (sFMR: 70%, 59%; sDMR: 49%, 31%; sUMR: 51%, 38%) and ischemia in FMR patients for FFS and MORE2 (68.7%, 76%). Claims analysis of sMR using real world data enables payers to define utilization metrics, which is paramount given the high burden of this disorder. These definitions have resulted in distributions across etiology that are consistent with expectations from clinical literature. Observed differences between data sources are likely attributable to variation in patient populations.

Associations of recent weight loss with health care costs and utilization among older women.

The association of weight loss with health care costs among older women is uncertain. Our study aim was to examine the association of objectively measured weight change with subsequent total health care (THC) costs and other health care utilization among older women. Our study population included 2,083 women (mean age 80.2 years) enrolled in the Study of Osteoporotic Fractures and U.S. Medicare Fee for Service. Weight loss and gain were defined, respectively, as ≥5% decrease and ≥5% increase in body weight, and weight maintenance as <5% change in body weight over a period of 4.5 years. THC costs, outpatient costs, hospitalizations, and skilled nursing facility [SNF] utilization were estimated from Medicare claims for 1 year after the period during which weight change was measured. The associations of weight change with THC and outpatient costs were estimated using generalized linear models with gamma variance and log link functions, and with hospitalizations and SNF utilization using logistic models. Adjusted for age and current body mass index (BMI), weight loss compared with weight maintenance was associated with a 35% increase in THC costs ($2148 [95% CI, 745 to 3552], 2014 U.S. dollars), a 15% increase in outpatient costs ($329 [95% C.I. −1 to 660]), and odds ratios of 1.42 (95% CI, 1.14 to 1.76) for ≥1 hospital stay and 1.45 (95% CI, 1.03 to 2.03) for ≥1 SNF stay. These associations did not vary by BMI category. After additional adjustment for multi-morbidity and functional status, associations of weight loss with all four outcomes were no longer significant. In conclusion, ≥5% weight loss among older women is not associated with increased THC and outpatient costs, hospitalization, and SNF utilization, irrespective of BMI category after accounting for multi-morbidity and impaired functional status that accompany weight loss.

Fracture Risk Assessment in Long-term Care (FRAiL): Development and Validation of a Prediction Model.

Strategies used to predict fracture in community-dwellers may not be useful in the nursing home (NH). Our objective was to develop and validate a model (Fracture Risk Assessment in Long-term Care [FRAiL]) to predict the 2-year risk of hip fracture in NH residents using readily available clinical characteristics. The derivation cohort consisted of 419,668 residents between May 1, 2007 and April 30, 2008 in fee-for service Medicare. Hip fractures were identified using Part A diagnostic codes. Resident characteristics were obtained using the Minimum Data Set and Part D claims. Multivariable competing risk regression was used to model 2-year risk of hip fracture. We validated the model in a remaining 1/3 sample (n = 209,834) and in a separate cohort in 2011 (n = 858,636). Mean age was 84 years (range 65-113 years) and 74.5% were female. During 1.8 years mean follow-up, 14,553 residents (3.5%) experienced a hip fracture. Fifteen characteristics in the final model were associated with an increased risk of hip fracture including dementia severity, ability to transfer and walk independently, prior falls, wandering, and diabetes. In the derivation sample, the concordance index was 0.69 in men and 0.71 in women. Calibration was excellent. Results were similar in the internal and external validation samples. The FRAiL model was developed specifically to identify NH residents at greatest risk for hip fracture, and it identifies a different pattern of risk factors compared with community models. This practical model could be used to screen NH residents for fracture risk and to target intervention strategies.

E-Prescribing and Adverse Drug Events: An Observational Study of the Medicare Part D Population With Diabetes.

Although the adoption of e-prescriptions among physicians has increased substantially under the Medicare Improvements for Patients and Providers Act and Meaningful Use programs, little is known of its impact on patient outcomes. To examine the impact of e-prescribing on emergency visits or hospitalizations for diabetes-related adverse drug events (ADEs) including hypoglycemia. This is a prospective, observational cohort study with patient fixed effects. 2011-2013 fee for service Medicare. In total, 3.1 million Medicare fee for service, Part D enrolled beneficiaries over age 66 with diabetes mellitus and at least 90 days of antidiabetic medications. E-prescribing was measured as the percentage of all prescriptions a person received transmitted to the pharmacy electronically. The outcome measure was the occurrence of an emergency department (ED) visit or hospitalization for hypoglycemia or diabetes-related ADE. Unadjusted results show that there were 21 ADEs per 1000 beneficiaries that had ≥75% of their medications e-prescribed. Beneficiaries with lower e-prescribing levels had significantly higher numbers of ADEs. We found a robust association between the greater use of electronic prescriptions in the outpatient setting and the lower risk of an inpatient or ED visit for an ADE event among Medicare beneficiaries with diabetes in our adjusted analysis. At the e-prescribing threshold of 75% and above, significant reductions in ADE risk can be seen. As an observational study, the results show an association but do not prove causation. Use of e-prescribing is associated with lower risk of an ED visit or hospitalization for diabetes-related ADE.

Abstract P199: Development of an Algorithm for Identifying Fatal Cardiovascular Disease in Medicare Claims

Introduction: Administrative claims data including Medicare are often used to study cardiovascular disease (CVD). Approximately one-third of CVD events are fatal, but claims data lack information on cause of death and claims-based analyses only include non-fatal outcomes. Objective: To develop claims-based algorithms to discriminate fatal stroke, fatal coronary heart disease (CHD), and fatal CVD (fatal CHD or stroke) from deaths due to other causes. Methods: We analyzed data for REasons for Geographic and Racial Differences in Stroke (REGARDS) study participants who died between January, 1, 2003 and December, 31, 2013, and were age ≥65.5 years and had at least 182 consecutive days of fee-for service Medicare coverage prior to their death. Deaths within 28 days following an expert-adjudicated stroke, CHD, and CVD event in REGARDS were defined as the gold standard. Logistic regression was used to develop algorithms including demographic data, ICD-9-CM diagnosis and procedure codes from Medicare claims for hospitalization and outpatient visits. We chose cut-points of predicted probability to define fatal stroke, CHD and CVD using these algorithms. Cut-points were chosen such that a similar proportion of participants had a fatal stroke, fatal CHD, and fatal CVD through REGARDS adjudication and the algorithms. Results: We analyzed data for 2,675 deaths among REGARDS study participants; 142 fatal strokes, 479 fatal CHD events, and 608 fatal CVD events. The algorithms are described in the footnote to the Table. C-statistics for the algorithms were 0.966 (95%CI 0.948, 0.980) for fatal stroke, 0.861 (95%CI 0.843, 0.878) for fatal CHD and 0.883 (95%CI 0.868, 0.898) for fatal CVD. Sensitivity, specificity, and positive and negative predictive values using cut-points of 24%, 30%, and 34% predicted probabilities for fatal stroke, fatal CHD and fatal CVD, respectively, are provided in the Table. Conclusion: The algorithms we developed can be used to identify Medicare beneficiaries with fatal CVD events.

Analysis of vertebral augmentation practice patterns: a 2016 update

ObjectiveTo evaluate procedure utilization patterns for vertebroplasty and kyphoplasty in the US Medicare population from 2004 to 2014.MethodsThe analysis was performed using the Centers for Medicare and Medicaid Services database...

Pre-fracture individual characteristics associated with high total health care costs after hip fracture.

The aim of this study is to estimate the associations of individual pre-fracture characteristics with total health care costs after hip fracture, using Study of Osteoporotic Fractures (SOF) cohort data linked to Medicare claims. Our study population was 738 women age 70 and older enrolled in Medicare Fee for Service (FFS) who experienced an incident hip fracture between January 1, 1992 and December 31, 2009. We assessed pre-fracture individual characteristics at SOF study visits and estimated costs of hospitalizations, skilled nursing facility and inpatient rehabilitation stays, home health care visits, and outpatient utilization from Medicare FFS claims. We used generalized linear models to estimate the associations of predictor variables with total health care costs (2010 US dollars) after hip fracture. Median total health care costs for 1year after hip fracture were $35,536 (inter-quartile range $24,830 to $50,903). Multivariable-adjusted total health care costs for 1year after hip fracture were 14% higher ($5256, 95% CI $156 to $10,356) in those with walk speed <0.6m/s compared to ≥1.0m/s, 25% higher ($9601, 95% CI $3314 to $16,069) in those with body mass index ≥30kg/m2 compared to 20 to 24.9mg/kg2, and 21% higher ($7936, 95% CI $346 to $15,526) for those with seven or more compared to no comorbid medical conditions. Pre-fracture poor mobility, obesity, and multiple comorbidities are associated with higher total health care costs after hip fracture in older women. Studies to investigate if targeted health care interventions for these individuals can reduce the costs of hip fractures are warranted.

Impact of radiographic vertebral fractures on inpatient healthcare utilization in older women

BackgroundVertebral fractures (VFx) are the most common osteoporotic fracture and are associated with higher risk of impaired function, additional fractures and death. The purpose of this analysis was to test the hypotheses that VFx are also associated with greater inpatient healthcare utilization. MethodsWe studied 4709 Caucasian women enrolled in the Study of Osteoporotic Fractures (SOF) and merged SOF cohort data with Medicare claims or Kaiser encounter data. To be included in this analysis, women had to be enrolled in Medicare Fee for Service or Kaiser as of 1/1/1991 and have radiographic information on VFx status at SOF Visit 3 (1991–92). VFx status was assessed using quantitative morphometry on lateral thoracic and lumbar spine radiographs. Prevalent VFx were defined as any height ratio>3 standard deviations below normal. Women were considered to have a clinical VFx if they reported a new diagnosis of VFx and a clinical radiographic report that confirmed that a VFx was present. Any hospitalization and the number of annualized days of hospitalization were identified through inpatient claims or encounter data. Specific hospitalizations for 5 major common reasons for hospitalizations were also examined. ResultsOver 5-years, 2632 (55.9%) women were hospitalized. In multivariate adjusted models, women with a prevalent radiographic VFx were 21% (95% CI, 2–44%) more likely to be hospitalized for any reason. This association was independent of a number of risk factors including smoking. The annualized rate of inpatient day was, however, similar, 1.67 and 1.48 among women with and without a VFx, respectively, p=0.49. Women with an incident clinical VFx were more likely to be hospitalized including women without evidence of a prevalent radiographic VFx (odds ratio (OR)=5.33; 95% confidence interval (CI)=1.81–15.71) and women with a prevalent radiographic VFx (OR=2.13; 95% CI, 1.05–4.33). Women with a VFx were more likely to be hospitalized specifically for hip fracture or chronic obstructive pulmonary disease (COPD) but not stroke, myocardial infarction or congestive heart failure. The association with COPD was attenuated to non-significance after adjusting for smoking. ConclusionOur results extend the potential public health impact of radiographic and clinical VFx to include an increased risk of any hospitalization.