CHEVY CHASE, Maryland—If proposed Medicare cuts that drastically reduce reimbursement for dual X-ray absorptiometry (DXA) are approved, most physicians will be unable able to offer DXA services in their offices, a new analysis by health care researchers predicted. Clinicians are organizing to resist the change, arguing that bone scans are underused and that adding more barriers to access is likely to lead to even more undetected osteoporotic fractures.
 
By 2010, the scheduled cuts would decrease reimbursement rates for DXA scans by 75%, to about $35 per test, making it impossible for 93% of physicians who currently offer DXA to provide this service, according to a survey conducted by the Lewin Group, Inc.¹ That is the year the  Deficit Reduction Act and Medicare Fee Schedule cuts would go into full effect.

Endocrinologists are leading the push to prevent this change. The Endocrine Society is supporting new legislation introduced by Congresswoman Shelley Berkley (D-NV) that would restore funding for DXA. The bill, HR 4206 "Medicare Fracture Prevention and Osteoporosis Testing Act of 2007," would restore reimbursement rates to the 2006 level of $140 per test.

The bill has been introduced in the house, but it has not been sent to a committee. There are currently 41 cosponsors but no companion bill has yet been introduced in the senate.

Cuts make no sense to endocrinologists

"This is already an underused service," said Janet B. Kreizman, senior director of
government and public affairs at the Endocrine Society in Chevy Chase. "Because it is an underutilized service and part of the ‘welcome to Medicare' package, we don't understand why it should be cut."

Currently, only about 20% of eligible Medicare patients have had their bone density measured, she said. Without an increase in prevention, the number of fractures due to osteoporosis is projected to increase by 50% by 2025.

If the proposed cuts are approved, access to DXA will be further restricted, which is likely to lead to a corresponding increase in the rate of fractures and their complications.

"To have this service available in-office is a great service because patients don't have to get it done somewhere else and their doctors can give the results a quality read," Kreizman explained. In rural areas, where there is limited access to centers that perform the test, there could be an increase in undetected fracture rates because people won't have access to the test, she elucidated.

"I have been doing bone density in my office for over 15 years," said Susan Sherman, MD, an endocrinologist in private practice in Denver, Colorado. As a result, "we are able to screen patients, recommend therapy, and follow their response to therapy."

The proposed cuts do not make sense to Dr. Sherman. "Medicare said patients over 65 should receive bone mineral density (BMD) testing," she said. "We are trying to intervene in these patients and protect them long-term, and there is a cost in providing this service. [With the proposed cuts,] reimbursement will fall to a level that won't allow us to perform DXA. It will barely cover the technicians' time."

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