by
Lauren Dubinsky, Senior Reporter | September 12, 2014
From the July 2014 issue of HealthCare Business News magazine
Additionally, the Medicare Payment Advisory Commission recommended this past March to decrease the hospital reimbursement rate for imaging services to match the office rate, if that rate was lower. For DXA, that would mean that the hospital rate would decline from $101 to $49.
“It’s just peculiar. The numbers are kind of all over the place,” says Fiorentino. “They clearly don’t reflect anything to do with the cost anymore, it’s just this random leveling of the playing field — whoever is higher gets cut.”
Physicians and patients are suffering
Fiorentino said that she has seen an 18.7 percent decline in the number of physician practices offering the service from 2008 to 2012.
Many of those sites had leases so they have already returned their machines. Those who don’t have a lease may still have their machines, but many have discontinued their maintenance contracts. “What a lot of doctors tell us is that they thought ‘OK, I will keep the machine and I will keep doing DXAs, but I’m not going to pay the $7,000 for the maintenance contract so when the machine goes, that’s it,’” says Fiorentino.
She says that because less physician practices are offering it, there has been a slight shift to hospitals, but not enough to make up for the loss. In part, hospitals are typically further from patients’ homes than doctors’ offices and with the patient base being elderly, the distance necessary to travel is a major factor in utilization of the service. According to ISCD data, because of the decline in the number of physicians offering DXA in their offices, DXA testing for older women using Medicare has dropped by 12 percent from 2008 to 2012.
But it’s even more of a problem now because testing was already underutilized before that time. ISCD found that over a nine year period, 41 percent of older women using Medicare had no DXA test.
“For a preventative service, for Medicare in particular, this is such a failure of public policy,” says Fiorentino. “It’s like the framework for the care of osteoporosis patients is imploding and that is not an exaggeration.”
David Lee, director of NBHA, has seen firsthand how the cuts have affected the patients. He says that before, patients were able to go down the hall to get a DXA scan after a doctor visit but now, especially if they live in a rural community, they may have to travel three to four hours to get it in a hospital.
“For some folks, especially if you think of those in their 70s and 80s and beyond that may need follow-ups with DXAs — it’s probably not going to happen,” he adds.
