Without Congressional action, Medicare payments for dual-energy x-ray absorptiometry will be cut in about half at the beginning of 2012.
But a small, bipartisan group of lawmakers in the House and Senate is pushing to extend DXA payment rates, which were passed as part of the Affordable Care Act and are set to expire at the end of this year, through 2013. Under the ACA, Congress instructed officials at the Centers for Medicare and Medicaid Services to increase DXA payments to 70% of the rate paid by Medicare in 2006.
The Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011 (H.R. 2020/S. 1096) was introduced at the end of May; it would keep the current DXA payment rate in place for 2 years.
Rep. Michael Burgess (R-Tex.), one of the bill’s sponsors, said that cutting DXA payments is shortsighted. "Osteoporosis and related bone diseases pose a public health issue of enormous proportions, affecting millions of Americans and costing billions of dollars," he said in a statement. "As a physician, I diagnosed and treated many patients during my 25 years of practicing medicine in Texas, and I saw firsthand the way osteoporosis affects patients and their families. The more we can do to promote and encourage education, awareness, and prevention, the better. Why Medicare will pay for a fracture, but not reimburse a reasonable amount for a scan that can prevent that fracture, is beyond me."
Medicare began cutting DXA payments in 2007, after Congress included bone densitometry among a group of high-cost imaging services that were slashed as part of the Deficit Reduction Act of 2005. Since then, physicians have been struggling to cover their costs as reimbursement steadily declined from around $148 per scan in 2006 to about $54 in 2010. Exacerbating the problem is that private insurers have largely followed Medicare’s lead, ratcheting down their reimbursements as well. The ACA brought DXA payments up to about $98.
Physicians’ organizations, including the American College of Rheumatology (ACR) and the American Association of Clinical Endocrinologists (AACE), are urging lawmakers to pass an extension of the current DXA payment rate
Dr. Timothy J. Laing, government affairs committee chair for the ACR and a rheumatologist at the University of Michigan, Ann Arbor, said that if the reimbursement for the test falls below current levels, it will become economically unsustainable for physicians to provide the test in their offices.
Patients still will be able to get a DXA scan in the hospital, but there are downsides to that limited access, Dr. Laing said. Patients are far more likely to get the test if it can be done at the time it’s recommended, he said, adding that providing DXA scans in the office also provides an opportunity for on-the-spot, in-depth counseling from a physician who is knowledgeable about both interpreting the test and treating osteoporosis.
Forcing patients to seek osteoporosis screening in the hospital also means higher Medicare copayments, and usually means longer waits to get the test, said Dr. R. Mack Harrell, secretary of the AACE and an endocrinologist in the South Florida area.
AACE officials are concerned that a drop in reimbursement for DXA will create access problems for Medicare patients, Dr. Harrell said. This is troubling, he said, because osteoporosis testing is a service that is touted by the CMS in its "Your Medicare Benefits" booklet as an important preventive service available under Medicare. "If Medicare is going to make this a priority item for retired people, they have to make it accessible," he said.
Already, many physicians have stopped offering DXA services because of fee cuts, Dr. Harrell said. The good news is that there are still a substantial number of office practices and outpatient centers that can afford to keep their DXA scanners operating at the current reimbursement levels. But Dr. Harrell cautioned that the current payment level is the break-even point for most physicians who are really "hanging on by their fingernails." If rates are cut again, it will become "fiscally impossible" to offer the service in the office, he said.
ACR’s Dr. Laing predicted that getting the legislation passed this year will be an uphill battle. The major issue is the cost of extending the current payment rate.
"Right now, Congress is deadlocked over the budget, so any bill that is introduced that adds costs to anything is going to be difficult." Conversely, Dr. Laing said he is encouraged because the bill has bipartisan support in both the House and Senate.