Government Cuts in Funding for DXA in Physicians' Offices May Lead to Difficulties for Rural Patients

Implications: It is well known that millions of people in the US suffer from osteoporosis which leads directly to debilitating fractures.   Early diagnosis of osteoporosis and low bone mass will help prevent chronic pain and loss of independence.  Once diagnosed, treatment is readily available and effective.  DXA of the hip and spine (central DXA) is the imaging procedure recommended for this diagnosis and monitoring for the effectiveness of treatment.  However, without legistative action, patient access to the central DXA may be compromised.

Analysis: Lack of availability of central DXA tests seems to me to be counterproductive to achieving better clinical outcomes, quality of life, and cost control.  The Centers for Medicare and Medicaid (CMS) policy decisions have already slashed reimbursement levels for central DXA testing outside a hospital setting.  Even more drastic reductions planned over the next two years make even less sense.  In 1997, Congress passed the Bone Mass Measurement Act that provided Medicare coverage for central DXA testing every two to three months for all estrogen-deficient women and others with specified conditions that increased the risk of bone disease.  In 2002, a task force recommended DXA testing for women between 60 and 64 at high risk and for all women 65 years and older.  Even with initiatives in 2004, the Surgeon General reported that testing was underused by those most needing it, causing a crisis in bone health.  As of 2007, these DXA tests still remain underused.  In fact, fewer than 20% of eligible women have taken advantage of DXA testing.  This is very puzzling because the occurrence of osteoporosis is expected to rise from 2-million people in 2005 to 3-million people in 2025.

It would seem logical that, in view of these facts, the CMS would structure coverage to encourage DXA testing.  But such is not the case.  While approximately 70% of all DXA testing equipment is in private physicians' offices, the Federal Government has adoped a plan to reduce payments for central DXA testing outside of hospitals by 64% by 2010 from $139 per test to $55 per test.  In January 2007, the reimbursement has already been reduced to $82.  These low reimbursements mean tht individual physicians can no longer afford to do the testing.  However, office settings are most convenient, especially in rural areas.  By forcing patients to be tested in hospitals, often located many miles away, local doctors cannot assist in the proper interpretation of results.

A second, but not less important, aspect is that health care costs will be reduced by early detection of osteoporosis through reduction of the incidence of fractures and their associated costs. Therefore, I would recommend that reimbursement rates return to the 2006 level.  Even with higher reimbursements, future health care costs will be less.