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Medical Groups Seek Boost in Pay for DEXA
  MedPage Today
April 09, 2009
HOUSTON, April 9 -- A coalition of medical organizations has mustered congressional support to overturn a planned cut in Medicare reimbursement for bone densitometry studies, which the groups say are already underpriced..
The Medicare Fracture Prevention and Osteoporosis Testing Act of 2009 has been introduced in the House (H.R. 1894) and Senate (S. 769) by multiple sponsors.
If passed by Congress, the legislation would restore Medicare reimbursement for dual-energy x-ray absorptiometry (DEXA) to the 2006 level of $140.
Over the past three years, reimbursement for DEXA decreased by 50% and will fall to $53 as of January 2010 without congressional intervention.
A multispecialty survey of 700 physicians showed that the proposed cut would drive most physicians out of the DEXA business.
Action Points
* Explain to patients that Medicare reimbursement for a test used to diagnose and monitor osteoporosis may decline to $53 in 2010, compared with $140 in 2006.
* A survey of physicians indicated that 85% would stop performing DEXA if Medicare reimbursement decreases to the $53 level.
"This will result in about 85% of doctors discontinuing the testing, so access to the test will be severely limited," Steven Petak, M.D., president-elect of the American Association of Clinical Endocrinologists (AACE), said in an interview.
A recent study by the Lewin Group, a Falls Church, Va., consulting firm, showed that no more than half of physicians would break even on DEXA if Medicare reimbursement were $134, added Dr. Petak, who's on the faculty of the University of Texas Health Sciences Center at Houston.
AACE is one of seven organizations that make up the DEXA Task Force. Other members are the National Osteoporosis Foundation, the American College of Obstetricians and Gynecologists, the American College of Rheumatology, the American Society for Bone and Mineral Research, the International Society for Clinical Densitometry, and the Endocrine Society.
DEXA is already underutilized by the very patients who have the most to benefit from the imaging study, according to a fact sheet developed by the coalition. Only about 13% of female Medicare beneficiaries eligible for DEXA actually undergo the imaging in any given year.
Ironically, DEXA is one of the preventive services included in the "Welcome to Medicare" exam, according to the fact sheet. Moreover, the Centers for Medicare and Medicaid Services (CMS) has established DEXA testing in eligible patients as a quality indicator of physician performance.
"One part of CMS is advocating doing more of the tests but another part is killing us with cuts in reimbursement," said Dr. Petak.
The study by the Lewin Group showed that restoring Medicare reimbursement for DEXA to the 2006 level would actually save money. Increased access to early detection and treatment of osteoporosis would save $1.14 billion over five years by preventing bone fractures, the study showed.
The DEXA Task Force also cited a recent study by Kaiser Permanente of Southern California, showing that increased use of DEXA testing followed by prompt treatment reduced hip fracture incidence by 37% over five years. Avoiding fractures led to an estimated savings of $30 million within the healthcare system in 2006 alone.
In March, 14 two-member teams representing AACE met with members of the House and Senate to state their case for increasing Medicare reimbursement for DEXA. Over the course of two days, the teams held more than 100 meetings with members of Congress.
"We received overwhelming interest and support from those individuals, and many of them have already signed up in support of the bill, and others indicated they are giving it serious consideration," said Dr. Petak.
Primary source: AACE Legislative Fact Sheet
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