Effect of Medicare Reimbursement Reduction for Imaging Services on Osteoporosis Screening Rates

Abstract

Background/Objectives In efforts to control costs, Medicare reduced reimbursement for office-based imaging services in 2007, an act projected to save $2.8B over 5 years. Many were concerned that imaging reimbursement reductions would reduce osteoporosis preventive bone mineral density (BMD) screening, which could lead to undiagnosed and untreated osteoporosis. The purpose of this study was to describe BMD testing rates and the proportion of women diagnosed after BMD screening versus an osteoporosis-related fracture before and after the 2007 Medicare reimbursement reductions. Design/Setting/Participants In a retrospective observational analysis of administrative medical claims reimbursement data, BMD screening services between 2005 and 2008 in women age 65+ with employer-sponsored Medicare supplemental coverage were evaluated. BMD testing and the incidence of patients whose first diagnosis for osteoporosis occurred with BMD screening versus as a result of osteoporosis-related fracture were identified by calendar year. Results A cohort of 405,093 women (average age 74.1 ±6.7 years) was identified of which 37.9% of study women received ≥1 BMD test during the study period. The proportion of women who received a BMD test was 12.9% in 2005, 11.4% in 2006, 11.8% in 2007, and 11.6% in 2008. Although testing rates varied, results were consistent with testing guidelines and did not decrease at a rate relative to reimbursement reductions as anticipated. Conclusion In an analysis of data from a medical claims dataset, BMD screening rates did not substantially decline during the 2 years after reimbursements reductions in Medicare-eligible women. Meanwhile, the proportion of women diagnosed after a fracture increased, although the nature of this increase is unclear.

Overuse of short-interval bone densitometry: assessing rates of low-value care

“…Medicare reimbursement for DXAs administered outside the hospital decreased substantially (from US$139 in 2006 to US$82 in 2007 and 2008, then to US$72 in 2009) under the Deficit Reduction Act of 2005 [11, 12]. In 2011, and retroactively for 2010, reimbursement was increased to 70 % of 2006 payment rates, or approximately US$98 per test [13].…”

“…Reimbursements for hospital-based testing were stable over this time frame [14]. These payment changes have been associated with a shift in testing from nonhospital to hospital settings and an overall slowing in the growth of DXA testing [14-16, 12]. The impact of these changes on health outcomes of patients is unclear [12].…”

“…These payment changes have been associated with a shift in testing from nonhospital to hospital settings and an overall slowing in the growth of DXA testing [14-16, 12]. The impact of these changes on health outcomes of patients is unclear [12]. It is equally unclear if payment changes resulted in slowed growth for all DXA testing or if the impact differed for more valuable, initial or longer-interval testing compared to low-value, clinically meaningless, short-interval repeat tests.…”

Distal Radial Fractures in Older Men

“…This study included few men and did not examine sex as a factor for success in assessing osteoporosis; however, it suggested that taking the lead in evaluating osteoporosis during the initial orthopaedic visit dramatically improved BMD testing and treatment rates. These practice patterns have endured among many of our surgeons and are likely responsible for the high rates of BMD evaluation and treatment among women in our study compared with national averages 48,56 . Although the rate of BMD testing for men also improved from 5% to 18%, men continued to demonstrate extremely low rates of BMD testing after distal radial fracture 55 .…”

“…Reported rates of BMD evaluation post fragility fracture were <20% a decade ago [45][46][47] . In response to these numbers, focused research initiatives were undertaken to increase osteoporosis screening and decrease future fracture burden [48][49][50] . The majority of this work focused on hip fractures in women 51 .…”