The Ability to Diagnose Osteoporosis in Danger
Cuts to Medicare reimbursement for Dual-energy X-ray Absorptiometry (DXA), or bone scans undermine doctors’ efforts to diagnose and treat osteoporosis.
Osteoporosis means "porous bones." Both women and men develop osteoporosis, or loss of bone density and minerals, especially calcium. Porous bones are brittle and more likely to break. Any bone in the body can be affected by osteoporosis, but the most common places for fractures to occur are the spine, hip, and wrist.
These "osteoporotic fractures" are a major source of pain, loss of mobility, isolation, disability, and healthcare expense in America. In his first term, George W. Bush declared 2002-2011 the United States Bone and Joint Decade, stating "...Advances in the prevention, diagnosis, treatment, and research of musculoskeletal conditions will greatly enhance the quality of life of our aging population."
Since that time, effectiveness of and options for osteoporosis treatments have indeed increased. And, many healthcare systems throughout the nation deployed the single most effective testing technology to determine who needed treatment most. DXA scanning is used to diagnose osteoporosis. It is central to the National Osteoporosis Foundation’s Guide to Clinicians on Prevention and Treatment of Osteoporosis.
Medicare recommends DXA testing once every 24 months and more often if medically necessary on its Preventative Services webpage. Patients are encouraged to have this test when first enrolling.
However, recent changes have reduced reimbursement to medical offices for DXA scans to levels that represent a net loss for many practices. "An important consequence is that the number of DXA facilities in the U.S. will likely decrease. This will necessarily result in fewer patients being diagnosed and treated to prevent fractures." says J. Edward Puzas, PhD, Professor and Associate Chair of Orthopaedics.
The American Association of Clinical Endocrinologists published a study that found that restoring DXA reimbursement to the higher 2006 levels would actually save the Medicare program $1.14 billion over 5 years due to the reduced number of osteoporotic fractures. They determined that the median reimbursement to medical offices for DXA scanning in 2007 was only 61% of the cost of providing the service.
In an opinion paper published in the November issue of Osteoporosis International, authors E. Michael Lewiecki, MD, S. Baim, MD, and E. S. Siris, MD, write "This is a case study of regulatory and legislative events that will likely result in harm, rather than benefit, to patients at risk for fracture."
Puzas agrees. He adds "The patients most likely to be negatively impacted are those in rural communities. They may have to travel 100 miles or more to a major medical center in order to have a DXA scan."
The URMC Center for Bone Health is a regional referral center for the diagnosis and treatment of bone disorders such as osteoporosis, calcium bone disorders, and metabolic bone disease. Our integrated group of specialists is dedicated to providing the most effective care possible to patients in and around the Rochester, NY nine-county region, as well as advancing care through research.
Currently, the URMC Center for Bone Health operates two DXA facilities:
Clinton Crossings (Brighton) and
Center for Bone Health DXA Scanning (Henrietta)
Related Links:
Dual-energy X-ray Absorptiometry (DXA)
United States Bone and Joint Decade
National Osteoporosis Foundation
Medicare Osrteoporosis Preventative Services
