Perfect Storm Brewing in Women's Bone Health, Says Physician Groups.

Medicare payment policies force doctors to abandon osteoporosis testing; osteoporosis related deaths surpass breast cancer; cuts actually add to burgeoning health care costs

HARTFORD, Conn. -- With new Medicare reimbursement rates for osteoporosis testing in effect just 9 months, nearly one-third of all physicians providing bone density screening will have eliminated this service from their practice by the end of the year. With additional cuts to reimbursement and full implementation by 2010, 93 percent of physicians say they will no longer provide osteoporosis screening in their practices, this according to a study conducted by a consortium of professional medical societies.

This reduced access to care comes as osteoporosis reaches epidemic proportions with 1 out of every 2 American women sustaining a fracture in their lifetime, yet less than 20 percent of eligible American women are tested annually. Osteoporosis related fractures currently add $16.9 billion to the national healthcare costs and lead to more deaths annually than breast cancer (20 percent of those who sustain hip fractures die within the following year). An additional 20 percent of those with hip fractures end up permanently living in a nursing home.

A low cost imaging test called DXA (dual energy x-ray absorptiometry) can identify people at increased fracture risk so they can start treatments before they break a bone. DXA is a key service included in the 'Welcome to Medicare' exam and has been a central component of many federal and state disease prevention and quality enhancement initiatives. DXA is universally recognized as the gold standard for the diagnosis and monitoring of osteoporosis treatment and was hailed by the Surgeon General in 2004 as "one of the most significant advances in the last quarter century" yet, it is this very test that threatens to be eliminated from the women's health care arsenal.

Unlike higher cost imaging services, the indications for DXA testing have been written by Congress so there is no potential for abuse. With a median cost of $134, DXA is a relatively low cost procedure that can be performed by the patient's primary physician or an osteoporosis specialist. Yet, DXA has received one of the deepest reimbursement cuts of all imaging services.

The Centers for Medicare & Medicaid Services' (CMS) cuts to DXA screening in the physician offices (where two-thirds of all tests are performed) when combined with congressionally mandated cuts to all imaging services as part of the Deficit Reduction Act will actually add to the national health care costs. A new study by the Washington-based Lewin Group estimates that retaining adequate payment for DXA would result in a five-year savings of $1.14 billion in the cost of treating osteoporosis due to fracture prevention.

The current Medicare reimbursement is approximately $81 - and it's projected to plunge to approximately $35 by 2010 when all the planned cuts are fully implemented. Unable to cover operating costs, most doctors in private practice have indicated they will be forced to give up DXA testing, leaving patients with diminished access to this critical service.

"Osteoporosis care in the United States is so seriously deficient that quality improvement and increased accountability has become a high priority for the medical community," said Richard Hellman, MD, FACP, FACE, President of the American Association of Clinical Endocrinologists. "Federal payment policies should not worsen the gap in care in one of the more seriously deficient areas of medical care in the United States."

"With nearly two-thirds of all DXA services provided by physicians outside of the hospital setting, the elimination of this service is a major blow to patient care," said Dr. Andrew Laster, Vice President of the International Society for Clinical Densitometry. "These cuts by CMS would cripple the exact preventive services that CMS is striving to develop, further jeopardizing women's health care and costing many additional lives."

About the International Society for Clinical Densitometry (ISCD)

The ISCD is a 7,000 member non-profit multidisciplinary professional society dedicated to excellence in the assessment of skeletal health. The ISCD provides continuing education courses for clinicians and technologists, advocates for patient access to osteoporosis testing and supports clinical and scientific advances in the field. The ISCD is based in West Hartford, Conn. Information about the ISCD is available at www.ISCD.org

About the American Association of Clinical Endocrinologists (AACE)

AACE is a professional medical organization with more than 6,000 members in the United States and 85 other countries. Founded in 1991, AACE is dedicated to the optimal care of patients with endocrine problems. AACE initiatives inform the public about endocrine disorders. AACE also conducts continuing education programs for clinical endocrinologists, physicians whose advanced, specialized training enables them to be experts in the care of endocrine disease, such as diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, cholesterol disorders, hypertension and obesity. Information about the AACE is available at www.aace.com.

About The American College of Rheumatology 

The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases.

The American College of Rheumatology, founded in 1934, is the largest professional organization of physicians, scientists, and health professionals devoted to the study and treatment of the rheumatic diseases. ACR members maintain a strong commitment to research and education, advancing the understanding of the rheumatic diseases, and discovering new therapies to treat these diseases.

www.rheumatology.org