Medicare Reimbursements For Bone Density Scans To See Drastic Reduction

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imageMedicare reimbursements for energy X-ray absorpitometry and DXA procedures are slated to be cut in half by January 1, 2012 as lawmakers scramble to avert the reductions.

Members of the U.S. House of Representatives and U.S. Senate last week introduced bipartisan measures intended to extend current reimbursement rates through 2013. Lawmakers behind the measures point out that health care expenditures will be higher, rather than lower, in the long run if senior citizens do not undergo X-ray absorpitometry or DXA scans, remain unaware that they suffer from osteoporosis, fail to undergo preventive treatment, and subsequently sustain hip fractures. The latter, they note, are far more costly to treat than the drug or other therapies that would have prevented them in the first place.

In a speech last Thursday on the Senate floor, U.S. Senator Olympia Snowe (R-Maine) states that without adequate Medicare reimbursement rates, “we most certainly risk losing the battle for improving access to bone density testing as well as preventing debilitating and costly bone fractures, an outcome we can ill afford.” Snowe deems osteoporosis a “major public health threat”, noting that a woman’s risk of fracture from it is higher than her annual combined incidence of breast cancer, heart attack, and stroke. Among those who suffer fractures, about 12% will die within six months and 20 percent require nursing home care, Snowe asserts, placing “even more strain” on the Medicaid budget.

Meanwhile, the American Association of Clinical Endorcrinolgoists has already warned that physicians will be forced to discontinue bone density scans because the Medicare payments will no longer cover the cost of the procedure. Medicare payments for the tests were, along with payments for many imaging services in physicians’ offices that were deemed “excessive”, first scaled back in tandem with the budget reconciliation bill enacted in early 2006. Changes in the physician fee schedule by CMS also had an impact. A subsequent provision in new health care law restored payments to 70% of their 2006 levels, but that boost will expire at the end of the year.