Please co-sponsor this legislation that provides a sustainable Medicare payment for dual energy x-ray absorptiometry (DXA) bone density scans performed in a physician’s office to help preserve beneficiary access to osteoporosis testing, prevention and treatment services.
What are osteoporosis testing, prevention and treatment services?
Osteoporosis causes bones to become brittle and porous, which causes bones to break. Osteoporosis testing is done by measuring bone density with a dual energy x-ray absorptiometry (DXA) machine. A DXA test identifies those who are at high fracture risk and is also used to monitor effectiveness of medical therapy to prevent and treat osteoporosis. DXA is considered the “gold standard” for osteoporosis testing by the medical community.
Why Is Maintaining Access to these Services so Important?
- 54 million Americans have low bone density or osteoporosis. Approximately one in two women and up to one in four men over the age of 50 will break a bone due to osteoporosis.
- In fact, 25% of women over the age of 50 who sustain a hip fracture die in the year following the fracture, 50% never walk independently again and 20% require permanent nursing home placement, at an enormous cost to government health programs.
- Medicare paid over $16 billion in 2010 for direct costs of new fractures and that number is projected to grow to over $25 billion by 2025.
- Older women who have a DXA have 35% fewer hip fractures than those who are not tested
- A DXA bone density test is now covered every 2 years as part of the Medicare Annual Wellness Visit, in addition to being part of the Welcome to Medicare exam
- Incentives for beneficiaries to utilize preventive health services, like a DXA test, will be meaningless if patients cannot access this service in their communities.
Medicare reimbursement for DXA has dropped from $140 in 2007 to $42 in 2018 – a payment reduction of 70%. Current payment rates do not cover the physician cost of providing these services, and as a result the capacity to provide DXA services within the healthcare system is being reduced and fewer women are being tested.