ALBUQUERQUE, New Mexico—If Medicaid reimbursement cuts for dual X-ray absorptiometry (DXA) are not reversed, there will be an epidemic of osteoporotic fractures. Moreover, the cost of caring for such fractures will far outweigh the savings in the cost from DXA services and medications to lower risk of fractures, warn 3 prominent osteoporosis researchers in the November issue of Osteoporosis International.1

Penny wise, bone foolish Medicaid cuts

The US Centers for Medicare and Medicaid Services (CMS) has reduced reimbursement for DXA to levels that are below the cost of providing this service at many facilities. These cuts occurred at the same time that Congress passed the Deficit Reduction Act (DRA) of 2005, which called for a decrease in reimbursement for DXA scans done in doctor’s offices. Taken together, there was a 40% reduction in Medicare payments for nonfacility DXA scans, down from $139 to $82. This will be cut to $55 by 2010. In addition, vertebral fracture assessment (VFA) reimbursement decreased from a 2006 level of $40 to $25 on January 1, 2007. By 2010, this fee will be reduced further to $19.

Restoring DXA reimbursement to its 2006 level of $139 per test, however, would actually save the Medicare program $1.4 billion over 5 years by reducing the number of costly fractures, the authors point out,

Fewer scans, more fractures predicted

“The consequence of the enacted legislative DRA cuts and progressive regulatory Medicare cuts in reimbursement for nonfacility DXA and VFA will be restriction of patient access to a key component of osteoporosis care,” the study authors warn. “Ultimately fewer patients at high risk for fracture will be identified and treated. As a result, there will be more osteoporotic fractures.”

Some office-based DXA facilities have stopped providing such services and more are expected to follow suit. There will also be an eventual, corresponding reduction in hospital-based DXA and VFA centers.

“With far fewer facilities providing DXA, more patients will be required to travel greater distances to have a bone density scan [and] there will be a discontinuity in care for those patients currently being monitored on osteoporosis treatments, since BMD measured by a DXA at an office-based or hospital-based facility cannot be quantitatively compared with a subsequent measurement performed at a new facility on a different DXA system, unless a cross-calibration study has been done,” the study authors write.

Some patients will simply choose not to undergo DXA due to inconvenience and travel costs.

To avoid these alarming scenarios, “we recommend that the CMS reimbursement strategies for DXA and VFA be reconsidered and realigned to be consistent with numerous federal initiatives intended to improve bone health in the US,” they write.

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