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. “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,” he said in a statement.
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, 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 is 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.
Getting the legislation passed this year will be an uphill battle. “Right now, Congress is deadlocked over the budget, so any bill that is introduced that adds costs to anything is going to be difficult,” Dr. Laing said.