Loading...Loading...Urinary incontinence affects millions of Americans, significantly impacting quality of life by limiting physical activity, reducing social engagement, increasing fall risk, disrupting sleep patterns and contributing to mental health concerns. Yet many patients suffer in silence due to embarrassment or the misconception that it's simply an inevitable part of aging.
Why this conversation matters
Primary care visits present valuable opportunities to address this often-overlooked condition. Consider that:
- Many patients accept incontinence as unavoidable, unaware of available treatments or that it can be a symptom of a more serious underlying condition.
- Some patients drop subtle hints about bladder control issues, hoping you'll initiate the discussion.
- Others may intend to mention symptoms but forget during the appointment.
- Most patients appreciate provider-initiated conversations about sensitive health topics.
Making the discussion routine
Incorporating urinary incontinence screening into your practice workflow can normalize these conversations:
- Include questions about bladder control in annual wellness assessments.
- Connect incontinence discussions with fall prevention counseling.
- Discuss how core-strengthening exercises (including Kegels) can address both fall risk and incontinence.
- Use matter of fact, clinical language that helps patients feel comfortable sharing symptoms.
Resources to support your patients
To reinforce your guidance and facilitate these important conversations, share the incontinence management educational materials with your patients. Flyers are available for men and women and in English and Spanish in our Quality Improvement Toolkit.
By addressing urinary incontinence proactively, you can significantly improve your patients' quality of life while supporting our quality improvement goals.
Approximately 25% of individuals 65 or older will experience a fall this year, and less than half of them will report it to their provider.
The Fall Risk Management Medicare Star Ratings measure is important for providers to understand because it is included in our member experience survey and the Health Outcomes Survey (HOS). Scores for this measure are based on memorable and impactful conversations you have with your patients regarding falls.
Effective patient support strategies
The discussions you have with our members can help them prevent falls and fall-related injuries. We suggest the following best practices:
- Conduct regular fall-risk screenings (annually or biannually) during patient visits
- Add prompts in your electronic medical record (EMR) for fall prevention discussions
- Implement the CDC Stopping Elderly Accidents, Deaths & Injuries (STEADI) algorithm
- Consider group fall prevention visits (e.g., Matter of Balance-coached events)
- Connect patients to community fall prevention resources (e.g., classes, tai chi, Matter of Balance)
- Recommend that patients assess their home for potential fall hazards (e.g., clutter, non-slip rugs, dim lighting)
- Encourage regular core-strengthening physical activity
- Review medications that may affect balance
- Address vision and footwear concerns
- Remind Medicare Advantage patients about extra benefits (e.g., Silver & Fit fitness program, PayForward home and bathroom safety equipment reimbursement)
Patient resources
Educational materials in English and Spanish are available in the Fall risk coaching category in the Quality Improvement Toolkit.
Osteoporosis management is a crucial component of comprehensive care that significantly impacts patient outcomes. Multiple organizations recommend that postmenopausal women who experience a fragility fracture be tested or treated for osteoporosis, including the National Osteoporosis Foundation and the U.S. Department of Health and Human Services (HHS).
The Osteoporosis Management in Women Who had a Fracture (OMW) Healthcare Effectiveness Data and Information Set (HEDIS®) and Medicare Star measure tracks care for women ages 67 to 85 on Medicare who have experienced a bone fracture. The measure assesses the percentage of women for whom bone mineral density (BMD) testing occurred, or osteoporosis medication was prescribed within the six months after the fracture.
Bone mass measurements performed by in-network providers are considered preventive services, covered at no cost to the patient, every 24 months or more frequently if medically necessary.
If your patient is interested in receiving a BMD test at home, have them call us at 1 (800) 541-8981 to see if this service is available through our partners. Test results are shared with both you and your patient.
Best practices
- Order a new BMD test if the previous one was more than two years prior to the fracture.
- Consider BMD testing for all women 65 and older, as recommended by the Bone Health and Osteoporosis Foundation.
- Confirm fracture via imaging before claim submission; submit corrected claims for fracture codes submitted in error.
- Document and submit claims for patients with frailty and advanced illness to exclude them from the measure; learn more about frailty and advanced illness in our Quality Measures Guide.
If your patient has had a fracture, order a BMD test or prescribe osteoporosis treatment within six months for better bone health and long-term fracture prevention.