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Bill may increase bone-mass measurement reimbursement
Underutilization of testing projected to put strain on Medicare as costs, fracture occurrences increase.
A new bill seeks to restore reimbursements for bone mass measurement tests to Medicare beneficiaries in order to increase their use and access to the tests.
If enacted, the Medicare Fracture Prevention and Osteoporosis Testing Act of 2007 (H.R. 4206) would set the minimum reimbursement rates for dual-energy X-ray absorptiometry (DXA) and vertebral fracture assessment (VFA) back to 2006 payment rates for all tests performed in 2008. The bill would also provide for the Institute of Medicine to study the effects of reimbursement reductions on beneficiary access to bone mass measurement tests and methods to increase beneficiaries’ use of this technology.
According to projections published in the Journal of Bone and Mineral Research (JBMR), less than 20% of eligible Medicare beneficiaries undergo testing. They predict that this underutilization will lead to a strain in the Medicare budget as the number of osteoporotic cases and costs of fracture treatment rise.
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Large increase
Furthermore the JBMR data indicate that more than 61 million people in the United States will have osteoporosis in 2020 and the number of osteoporosis fractures will increase by 50% in the next 20 years. The cost of a 50% increase in fractures by 2025 will be just over $25 billion.
Reimbursement cuts also limit the use of bone mass measurement testing. Congress found that DXA reimbursement in nonhospital settings has dropped by 40% and is expected to fall by 64% in 2010.
“This drop represents one of the largest reimbursement reductions in the history of the Medicare program,” the authors of the bill wrote. “Reimbursement for VFA will also be reduced by 50% by 2010.” The drops in reimbursement therefore hinder physicians from providing in-office testing, according to the bill.
“Essential” for care
Orthopedics Today editorial board member Laura L. Tosi, MD, said that issue is about more than just saving money. Research has shown that DXA tests play a significant role in predicting fracture risk, and the studies can play a critical role in improving patient compliance. The tests can also help physicians assess the efficacy of treatment and aid them in determining if a patient’s treatment should be modified.
“It is absolutely essential for good quality care,” she said.
For more information:
- Laura L. Tosi, MD, is the director of the bone health program at Children’s National Medical Center. She can be reached at 111 Michigan Ave. NW, Washington, D.C. 20010; 202-476-4152; ltosi@cnmc.org.
Reference:
- Burge R. Dawson-Hughes B. Solomon DH. Et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2007;22(3):465-475.