Medicare and DXA Reimbursement
NOF advocates for
policies that support early
detection of osteoporosis and
low bone mass. Access to
adequate care and osteoporosis
screening can ensure
osteoporosis patients, and those
at risk for the disease, have
optimal treatment options.
NOF
urges Members of Congress to
protect patient access to high
quality osteoporosis prevention,
diagnosis and treatment by
cosponsoring HR 1293.
By 2010, Medicare
reimbursement rates for DXA
testing for osteoporosis in
settings outside of hospitals
will have dropped by
approximately 75%. This new
Medicare policy may force many
doctors to discontinue providing
this procedure resulting in
reduced
patient access to
DXA tests, failed prevention
efforts, and compromised quality
of care.
-
Prevention
Efforts Fail: Currently,
only about 20% of eligible
Medicare patients have had
their bone density
measured. Without an
increase in preventive
efforts, the number of osteoporotic fractures is
projected to increase
approximately 50% by 2025,
leading to an annual cost of
over $22 billion. Reducing
DXA availability in
physicians’ offices will
doom efforts to reduce the
number, morbidity, mortality
and cost of these
fractures.
-
Reduced
Access for Medicare Patients
in Rural Areas: Medicare
beneficiaries in rural areas
may be forced to drive long
distances for DXA testing
due to a lack of providers.
The inconvenience or
hardship imposed may create
a barrier to care and
contribute to the failure of
preventive efforts.
-
Reduction in
Quality of Care: Optimal
osteoporosis care requires
the synthesis of each
individual’s clinical risk
factors with their bone
density value to assess
their risk for fracture.
Patients may well lose the
benefit of having their
physician’s knowledge of
their medical history
integrated into the
interpretation of the test
results.
Background:
-
The 2004 U.S.
Surgeon General’s Report on
Bone Health and Osteoporosis
states that much more can be
done with what is already
known about preventing,
diagnosing and treating
osteoporosis. The Surgeon
General states that unless
the U.S. acts now, “in 2020
one in two Americans over
the age of 50 will have, or
be at high risk of
developing, osteoporosis.”
-
The U.S.
Preventive Services Task
Force Recommendations on
Osteoporosis
urge routine osteoporosis
screening for all women age
65 and older to identify
those at risk for fracture
and that routine screening
begin for women age 60 at
increased risk for
fractures.
-
The World
Health Organization
and the
US Surgeon General
recognize central DXA
testing as the standard of
care for osteoporosis
prevention, diagnosis and
treatment.
-
The Centers for Medicare
and Medicaid Services
(CMS) recognizes DXA testing
for osteoporosis as one of
its key preventive services
for its “Welcome to
Medicare” visit.
Click here to learn more about
NOF public policy priorities and
legislative campaigns.
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