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Bone Densitometry - Reimbursement remains low but new indications may breathe new life

por Lauren Dubinsky, Senior Reporter | July 17, 2015
Medical Devices Women's Health X-Ray
From the July 2015 issue of HealthCare Business News magazine

Among U.S. women age 55 and older, osteoporotic fractures have a bigger hospitalization burden than heart attack, stroke, or breast cancer, according to a recent Mayo Clinic study. Yet the reimbursement rate for the bone density test, dual-energy X-ray absorptiometry (DXA), is at an all-time low. “Looking at the trends over the past six to eight or more years, we have not been headed in the right direction and that certainly is concerning,” says Dr. Andrea Singer, lead author of the study and clinical director of the National Osteoporosis Foundation (NOF).

When compared to breast cancer and cardiovascular disease, patients don’t view osteoporosis as an important health risk. But it accounts for about 2 million osteoporotic fractures per year, which translates to 500,000 hospitalizations, 800,000 emergency room visits and 2.6 million physician office visits, according to the U.S. Department of Health and Human Services.

“Clearly osteoporosis and its consequences are significant, and yet it is under recognized by patients as well as providers in terms of how prevalent it is and what impact it has on duration of life, quality of life and cost to the health care system,” says Singer. But the solution to this problem is not clear cut. With reimbursement floundering, many providers are opting to jump ship and as a result, patients have increasingly less access to these important DXA exams.

Many organizations including the NOF, National Bone Health Alliance (NBHA), International Society for Clinical Densitometry (ISCD), and the American Society for Bone Mineral Research (ASBMR) are making every effort to turn this trend around. However, no one is certain what the future of bone densitometry will hold.

In 2007, DXA reimbursement for physician practices stood at $139, but eight years later that has plummeted to $40. In addition, CMS has recently decided to bundle DXA with vertebral fracture assessment (VFA), which is a test that identifies vertebral abnormalities and gives physicians more information to diagnose osteoporosis.

If a physician performs DXA and VFA on the same day, those services will be billed together at a lower rate than if they were billed separately. Donna Fiorentino, legislative council for ISCD, says this is a huge problem because VFA was already an underutilized procedure and now there is almost no incentive for it to be performed.

Many physician practices are discontinuing DXA service — from 2008 to 2012 there has been an 18.7 percent decline in physician practices performing DXA exams, according to the ISCD. The hospital reimbursement rate is $99 but they are also being affected by the bundling.

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