Protect Patient Access to
Osteoporosis Testing
Problem:
Patient access to high quality
care for osteoporosis is
threatened by new Medicare
policy. Medicare revisions
enacted under the Deficit
Reduction Act (DRA) dramatically
reduce physician reimbursement
for dual energy x-ray
absorptiometry (DXA) testing of
the hip and spine.
One in two women and one in four
men age 50 and older will have
an osteoporosis- related
fracture in their lifetimes.
The “gold standard” for testing
persons at risk for osteoporosis
is DXA testing of the hip and
spine, according to the US
Surgeon General and the Centers
for Medicare and Medicaid.
Although DXA testing was
included in the DRA legislation
to reduce over-utilized,
expensive imaging tests, bone
mineral density tests are
under-utilized – only about 20
percent of those individuals who
are eligible for bone density
testing are actually being
tested. Furthermore, bone
mineral density tests are
considered relatively
inexpensive – in 2006 they were
approximately $140. According
to a recent study cited in the
US Surgeon General’s Report
on Bone Health and Osteoporosis,
the overall lifetime cost of a
hip fracture could be as high as
$81,000.
New Medicare policy could force
doctors to discontinue providing
tests for osteoporosis to their
Medicare patients in physician’s
offices and imaging clinics
because the reimbursement level
is below the actual cost to
perform the procedure. As a
result, patient access to DXA
tests would be significantly
reduced as patients are unable
to find a physician or unable to
travel to the nearest DXA
provider.
Solution:
Solution: NOF urges Congress to protect patient access to high quality
osteoporosis prevention,
diagnosis and treatment. You can
help by asking your Senators and
Representative to:
-
Cosponsor the “Access to
Medicare Imaging Act of 2007”
(S. 1338H.R. 1293). This
legislation enacts a two-year
delay in the Medicare imaging
cuts under DRA so the impact of
cuts in reimbursement can be
studied by the Government
Accountability Office (GAO).
These bills also exclude DXA
testing from the DRA
reimbursement reductions.
Click here to support this
legislation & join the NOF Bone
Health Advocacy Network!
New Medicare payment policy
for DXA testing threatens the
success of governmental
initiatives to increase fracture
prevention efforts. In
addition, because Medicare and
Medicaid are major payers of
fracture treatment, creating
barriers to central
DXA testing
may also increase government costs.
Facts on
Osteoporosis:
An estimated 44
million people who currently
have low bone mass or
osteoporosis represent 55% of
the people age 50 and older in
the United States. According to
the US Surgeon General:
-
Osteoporosis is responsible
for more than 1.5 million
fractures in the US that
lead to 800,000 emergency
room encounters, more than
2.6 million physician office
visits, and the placement of
180,000 individuals in
nursing homes.
-
The government pays for most
of the costs of osteoporotic
fractures; Medicaid covers
almost one-quarter of the
expense and Medicare pays
nearly one-half.
-
The estimated annual
national costs of direct
care (e.g. nursing homes,
hospitals) for osteoporotic
fractures are $18 billion in
2002 dollars and the cost is
rising.
Click here for more background
on DXA and Medicare
Reimbursement.
