Sunday, August 15, 2010

Osteoporosis Testing with DXA

One of the good things that has come out of the Affordable Care Act (the name for Health Care Reform) is that the payments to providers who do DXA screening for osteoporosis will increase immediately from Medicare and Medicaid.  Unfortunately these increased payments expire at the end of 2011.  To show how crazy the Medicare payment policies are, in 2006 the DXA service was reimbursed at $143.00.  Now the fee for the same  CPT code 77080 is $45.00 and it will increase to $98.00.  So the increased payment now is still only 70% of the payment in 2006 and there is no guarantee it won't be ratcheted down again.

The cost of a new DXA dual energy Xray absorptiometry machine is about $35,000 and the life span is about 8-10 years.  Training for employees, space and variable costs to run the program are added to this.  A patient's access to this test depends upon where they live.  In large metropolitan areas, most hospitals offer DXA testing.  But it doesn't take advanced math to see that this would not be a good investment by a small clinic or doctor's office and patients in smaller communities will have difficulty finding this test.

Identifying and treating bone loss early results in savings later from hip fractures and hospitalizations.  Until we start looking at the entire cost of care for certain high-risk conditions, we will never be making the right decisions on where to invest money.  Vitamin D screening and DXA screening are important for high risk patients so we can identify them and start early treatment.  The costs spent on these tests is minuscule compared to the cost of hospitalization, surgery and nursing homes after the fact.

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