Medicare reimbursement cuts for DXA place osteoporosis care at risk, authors claim

Cuts to Medicare reimbursement of dual-energy X-ray absorptiometry (DXA) undermine efforts to properly diagnose and treat osteoporosis and diminish the quality of patient care, according to a group of researchers.

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, stated that Medicare reimbursement for DXA has been cut to levels substantially below the cost to perform the procedure. As a result, many physicians and clinics around the country are likely to discontinue this critical health service, greatly limiting the public’s access to the test and jeopardizing those at risk for a fracture, the researchers said in a press release.

The anticipated reimbursement cuts run contrary to existing federal initiatives already in place to increase fracture prevention efforts and improve the prevention, diagnosis and treatment of osteoporosis, they wrote in their paper.

They suggested that DXA is “a key tool” in identifying those at risk for osteoporosis and helping those with the disease monitor their bone health. They also pledged their support for “federal efforts to contain health care costs and eliminate unnecessary medical services.”

However, with the Medicare cuts in reimbursement, “Fewer patients at high risk for fracture will be identified and fewer patients will be treated,” they wrote in their paper. As a result, there may be more osteoporotic fractures.

“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,” they wrote.

The authors also cited a recent study by The Lewin Group, which found that restoring DXA reimbursement to the 2006 levels would save the Medicare program $1.14 billion over 5 years due to the reduced number of osteoporotic fractures.

Osteoporosis now causes an estimated 2 million fractures each year and often results in immobility, pain, placement in a nursing home, isolation and other health problems — conditions and circumstances that could largely be prevented through proper bone density testing and diagnosis, according to the press release.

Reference:
Lewiecki EM, Baim S, Siris ES. Osteoporosis care at risk in the United States. Osteoporosis Int. 2008;19:1505-1509.