Ramifications of More DXA Cuts! We Need Your Help!

Pam Flores @phflores Health Guide
  • I hope you've been following the news on Congress' legislative bill HR 2020/S. 1096, The Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011.  This bill is to preserve the pre-2006 cuts to DXA's reimbursement rates through Medicare, which are at an all time low and unaffordable for most. We all need to send our representatives letters and make phone calls to stop this travesty before it's too late.  You can voice your opinion at the International Society of Clinical Densitometry (ISCD) in a pre-written form to stop this. 


    These massive cuts we've seen over the last 6 years for Medicare beneficiary's has had a huge impact on all patients, and we know DXA is responsible for a 20% reduction in fractures in the last 6 years according to the ISCD.

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    Recently the Journal of the American Medical Assocation (JAMA) published recommendations telling us who should have a DXA scan and who could wait years for their first scan.  This recommendation was suppose to save important health care dollars, but we know that is not what will happen.  Since the DXA reimbursement rate is at $56.00 again and looking like we could loose the reimbursement altogether what difference does it make to put out these recommendations if Medicare isn't going to pay enough for the average patient to afford the test.


    We know that DXA is an under-utilized test, since under 12% of Medicare beneficiaries actually have it done, which means many go without warning on bone loss and as a result may suffer in silence since they don't know their bone mass is declining.  There's a reason it's called the silent disease.  In most cases there are no side effects to warn us in advance, we usually find out we have bone loss after it's already at the osteoporosis stage, or we have a fracture which in most cases may be too late.


    If we continue to ignore this test because we can't afford it, that means an increase of fractures, resulting in huge medical bills, treatment costs, and many more admissions into nursing homes for those who've fractured a hip and declined from inactivity-related blood clots, all because the patient didn't even know they had low bone mass.


    When are we going to wake up?  It's obvious to me that we can't count on our insurance companies to cover this completely or at reasonable co pay, so we have to do something before this very necessary test disappears entirely.


    Doctors who have these scanners are having to lay-off vital personnel who run the machine; sell off their scanners and the worst part stop recommending its use along with putting patients at-risk.  Doesn't anyone see the problem with this?  We have other types of bone scanners, like the ultra-sound heel scan but these aren't comparable to a DXA they are only good for pre-screening to determine who actually needs a DXA.  No doctor will take the results of a heel scan as a diagnosis since it's not capable of providing that type of information, nor can you track treatment benefits with it.


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    Here's the problem.  The current reimbursement rate is at $56.00 for a test that cost much more than that.  Most Medicare beneficiary's can't afford to pay the difference between $56.00 and the total cost of DXA, so they didn't have the test, which resulted in 12,000 more unnecessary fractures that could have been prevented since 2006.


    Here's the solution.  According to the ISCD In order for this trend of declining DXA testing to be reversed, we need to find a permanent resolution to declining and inadequate reimbursement.  So please contact your representatives and ask them to sign on as a co-sponsor of H.R. 2020/S. 1096.


    One last thing; don't become complacent because you aren't a Medicare beneficiary, and wonder "what does this have to do with me."  Medicare is the largest insurance in this country and most private health insurances follow Medicare's lead on these decisions.  So your private insurance may be on the verge of implementing this as well, so it does affect you.


    Won't you please help and sign the letter, and then send it to your local representatives in office?  Together we CAN do this to save a vital test, many lives, unnecessary fractures and more nursing home admissions.






    1. The Endocrine Society-Advocacy, Congressional Support Needed to Extend DXA Payment Fix, by Endocrine Insider July 28, 2011  http://www.endo-society.org/advocacy/insider/2011/CongressionalSupportNeededtoExtendDXAPaymentFix_art3.cfm


    1. The International Society for Clinical Densitometry, Medicare Payment Cuts Aggravated Underuse of "DXA" Osteoporosis Test. Retrieved April 17, 2012 http://www.iscd.org/Visitors/positions/Advocacy.cfm


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Published On: April 27, 2012