Public Policy Issues

Great News--DXA Relief is Finally Here! (3.21.10)
 
The evening of March 21, the United State Congress passed Health Care Reform legislation that included some relief from the Medicare cuts to DXA.  The House passed HR 3590, the Patient Protection and Affordable Act which was already passed by the Senate in December.  The bill is expected to be signed by President Obama shortly. 

The DXA provision adopted by the House on March 21 requires Medicare to reimburse DXA and VFA during 2010 and 2011 at no less than 70% of the 2006 rates. This means that DXA will be reimbursed at approximately $98 and VFA at $27.  These new rates will go into effect as soon as the President signs the bill and are retroactive to January 1, 2010.  ISCD and our partners will begin immediately working to determine the mechanics of how CMS will handle the retroactive payments for DXAs performed in the first three months of this year. We will keep you posted with more details as they become available.
 
Many thanks to all of you who have helped in our efforts over the past few years; your hard work has paid off.  We celebrate this success with you. ISCD will continue to ensure that quality osteoporosis testing remains an important preventive health care priority in Congress.

Visit our Advocacy Web site for further updates (www.ISCD.org/advocacy).

Patient Protection and Affordable Care Act - DXA Provision Text (Section 3111 of HR 3590)

SEC. 3111. PAYMENT FOR BONE DENSITY TESTS.

(a) Payment-

(1) IN GENERAL- Section 1848 of the Social Security Act (42 U.S.C. 1395w-4) is amended--

(A) in subsection (b)--

(i) in paragraph (4)(B), by inserting `, and for 2010 and 2011, dual-energy x-ray absorptiometry services (as described in paragraph (6))' before the period at the end; and

(ii) by adding at the end the following new paragraph:

`(6) TREATMENT OF BONE MASS SCANS- For dual-energy x-ray absorptiometry services (identified in 2006 by HCPCS codes 76075 and 76077 (and any succeeding codes)) furnished during 2010 and 2011, instead of the payment amount that would otherwise be determined under this section for such years, the payment amount shall be equal to 70 percent of the product of--

`(A) the relative value for the service (as determined in subsection (c)(2)) for 2006;

`(B) the conversion factor (established under subsection (d)) for 2006; and

`(C) the geographic adjustment factor (established under subsection (e)(2)) for the service for the fee schedule area for 2010 and 2011, respectively.'; and

(B) in subsection (c)(2)(B)(iv)--

(i) in subclause (II), by striking `and' at the end;

(ii) in subclause (III), by striking the period at the end and inserting `; and'; and

(iii) by adding at the end the following new subclause:

`(IV) subsection (b)(6) shall not be taken into account in applying clause (ii)(II) for 2010 or 2011.'.

(2) IMPLEMENTATION- Notwithstanding any other provision of law, the Secretary may implement the amendments made by paragraph (1) by program instruction or otherwise.

(b) Study and Report by the Institute of Medicine-

(1) IN GENERAL- The Secretary of Health and Human Services is authorized to enter into an agreement with the Institute of Medicine of the National Academies to conduct a study on the ramifications of Medicare payment reductions for dual-energy x-ray absorptiometry (as described in section 1848(b)(6) of the Social Security Act, as added by subsection (a)(1)) during 2007, 2008, and 2009 on beneficiary access to bone mass density tests.

(2) REPORT- An agreement entered into under paragraph (1) shall provide for the Institute of Medicine to submit to the Secretary and to Congress a report containing the results of the study conducted under such paragraph.

ISCD Public Policy Update: DXA Cuts Addressed in Senate Health Care Bill (11.13.09)

In the past month, ISCD and our coalition partners cleared a major hurdle in our efforts to address the DXA cuts. Chairman Max Baucus included a provision to remedy the DXA cuts in the much debated Health Care Reform Bill (S.1796, America’s Healthy Future Act) that was approved by the Senate Finance Committee on October 13, 2009. The DXA provision included in this bill would require CMS to reimburse DXA for 2010 and 2011 at approximately $97, as opposed to the $45 level that is scheduled for next year. The provision also calls for a study to evaluate the effect of the DXA cuts on patient access to care. The Baucus bill will be merged with another health care reform bill approved by the Senate HELP (Health, Education, Labor and Pensions) Committee. The merged bill will then be sent to the Senate floor for a vote possibly as early as next week.

Unfortunately, the DXA cuts were not addressed in the House version of the Health Care Reform legislation, H.R.3962, America’s Affordable Health Choices Act. This legislation was narrowly approved by the House on November 7th. It is clear that there will be significant differences in House and Senate versions. At some point, the two bills will need to be reconciled in a conference committee made up of both House and Senate members.

As you can see, the process is far from over. While we are encouraged by our success in the Senate Finance Committee, we know there is considerable work to do. In the House, we need more bill sponsors to H.R. 1894 (Medicare Fracture Prevention and Osteoporosis Testing Act). In the Senate, we need to make sure that our support there stays strong and that the DXA provision remains part of the bill.

As always, many thanks to all of you who have responded to our requests for letters and calls to targeted Congressional offices over the past few months. In our most recent campaign, your efforts generated over 2000 emails to 314 Representatives and 91 Senators. This communication, our largest effort yet, helps to solidify our support as the process continues and is critical to our success. We know we can count on your help in the coming weeks as we continue our work. Thank you for your continued response to our “Calls to Action,” and for passing along our information to your colleagues to generate an even greater response.

You can help right now by:

• Responding to our request for help in targeted districts;
• Checking to see if your Representative or Senator is listed as a sponsor of the DXA bills: H.R. 1894 and S. 769, The Medicare Fracture Prevention and Osteoporosis Testing Act of 2009. Currently we have 118 sponsors in the House and 15 in the Senate. Click here to see the list of current sponsors. If your Representative or Senator is not a sponsor, please send an e-mail to them by clicking here. Increasing the number of sponsors will help us in our lobbying efforts in the coming weeks and months.

DXA Cuts Addressed in Senate Health Care Bill (10.21.09)

In the past few weeks, ISCD and our coalition partners cleared a major hurdle in our efforts to address the DXA cuts. Chairman Max Baucus included a provision to remedy the DXA cuts in the much debated Health Care Reform Bill (S.1796, America’s Healthy Future Act) that was approved by the Senate Finance Committee on October 13, 2009. The DXA provision included in the Senate bill would require CMS to reimburse DXA for 2010 and 2011 at approximately $97, as opposed to the $45 level that is scheduled for next year. The provision also calls for a study to evaluate the effect of the DXA cuts on patient access to care. The Baucus bill will be merged with another health care reform bill approved by the Senate HELP (Health, Education, Labor and Pensions) Committee. The merged bill will then be sent to the Senate floor for a vote.  

In the House, Health Care Reform bills were voted out of three different Committees who share jurisdiction regarding health care policy. (They are the House Committees on Education and Labor, Energy and Commerce and Ways and Means.) Each Committee voted out a portion of HR 3200, America’s Affordable Health Choices Act.

Unfortunately, at this point, the DXA cuts have not been addressed in any of these bills. However, there is still hope of getting a remedy included in the final House bill.  All three parts of HR 3200 have now been referred to the House Rules Committee to be merged into one bill before being sent to the House floor for a full vote. The next opportunity to get DXA included in the House bill is in the Rules Committee or by House leadership who also play an integral role in crafting the final document that will be voted upon by the full House of Representatives.

It is likely that there will be significant differences in the versions of the Health Care Reform Bills that are adopted by the House and the Senate. At some point, the two bills will need to be reconciled in a conference committee made up of both House and Senate members.

As you can see, the process is far from over. While we are encouraged by our success in the Senate Finance Committee, we know there is considerable work to do both in the House, as we try to get our DXA provision included in the final bill, and in the Senate to make sure that our support there stays strong to insure that the DXA provision remains part of the bill.

As always, many thanks to all of you who have responded to our requests for letters and calls to targeted Congressional offices over the past few months. We know we can count on your help in the coming weeks as we continue our work.

You can help right now by:

• Responding to our request for help in targeted districts;
• Checking to see if your Representative or Senator is listed as a sponsor of the DXA bills: HR 1894 and SB 769, The Medicare Fracture Prevention and Osteoporosis Testing Act of 2009. Currently we have 117 sponsors in the House and 15 in the Senate. Click here to see the list of current sponsors. If your Representative or Senator is not a sponsor, please send an email to them by clicking here. Increasing the number of sponsors will help us in our lobbying efforts in the coming weeks and months. 

Update on DXA in DC
CMS Proposes More Cuts; DXA Bill Gains Sponsors

On July 1, 2009, CMS proposed a new rule (CMS-1413-P) that would further reduce DXA reimbursement. As part of the Physicians Fee Schedule, which is published every June,CMS announced that DXA would receive further cuts in 2010, dropping reimbursement by another $8.00, and bringing the national average reimbursement to $45.00. The additional cuts to DXA proposed for 2010 are the result of a decrease in the malpractice and practice expense components that make up the reimbursement rate. ISCD is analyzing these cuts and will file comments in opposition by the August 31st deadline.

The ultimate irony is that CMS is proposing further cuts toDXA at the same time Congress continues touting the benefits of prevention in its healthcare reform debate. The additional cuts to DXA come at a time when ISCD, AACE, NOF and our other partners are trying to reverse cuts that have already been implemented during the past three years.Along with our coalition, ISCD continues to fight for the passage of H.R. 1894 and S. 796, The Medicare Fracture Prevention and Osteoporosis Testing Act of 2009, in which DXA would be reimbursed at 2006 levels. The DXA bill has broad bi-partisan support with 14 co-sponsors in theSenate and 107 in the House.

The Senate and House Committees continue to work on producing a health care reform package—legislation that provides an opportunity to address the DXA cuts.Unfortunately, at this point, the health care reform bills do not restore funding for DXA cuts. The House bill did includea study of bone mass measurement, including CT, DXA and VFA. The study would focus on: 1) the cost of providing the service; 2) the impact of the cuts on patient access; 3) a review of the clinically appropriate and recommended use of bone mass measurement for Medicare beneficiaries; and 4) how testing rates for bone mass measurement compare to those recommendations. Despite talking up the benefits of prevention, the Congressional Budget Office (CBO) will not “score” or include the price of estimated health care savings when calculating the cost of a bill. Thus, our legislation would cost approximately $140 million/year for each of the next two years, but the CBO can not include the savings from reduced osteoporotic fractures when calculating the overall cost of the bill.

The good news is that Congress is clearly aware that there is a problem with Medicare cuts to DXA testing. Please remember, there are still realistic opportunities for us to get the cuts restored this year by amending the health care reform bill in Committee or when it comes up for a vote by the full House or Senate. ISCD and our partners are pursuing every avenue to that end. This includes ongoing discussions with members in the House and Senate across all spectrums of political opinion with a particular focus on those serving on key committees involved in drafting the new health care legislation.

You can help in a variety of ways. When you finish reading this article, take a minute, visit our Advocacy Web site (www.ISCD.org/advocacy) and send a new e-mail to your Congressional delegation that addresses where we are in the process today. As we move through the legislative process during the next days and weeks, we will target our efforts on members who sit on key committees or who have particular clout with regard to this bill. If you receive an e-mail from ISCD, please continue to respond the way you have in the past. It is your commitment and responsiveness that has gotten us this far. Our message to Congress is clear — DXA is a test that saves money and saves patient lives. If prevention is indeed at the top of its list, Congress should embrace DXA as a proven model for chronic disease prevention and restore funding to viable levels.

DXA Days in DC a Success, the Time is Now to Contact Your Congressional Delegation!

In early June, we headed to DC with over one dozen ISCD members and patients to spread our message on S. 769 and HR 1894-the bills to restore the DXA cuts. ISCD and its partners met with over 80 Representatives and Senators and over one-half of these meetings were organized by ISCD. As Congress gets set to deal with Health Care Reform, our meetings could not have been timelier. With the focus on prevention, we presented DXA testing for osteoporosis as the perfect tangible example of a prevention program that both works and is cost-effective.

In addition to a lengthy schedule of Congressional visits, we also participated in a Legislative Reception on the evening of June 9th and a Capitol briefing on June 10th. Both Representatives Berkley and Burgess spoke at the briefing, which was well attended by Congressional staff. Dr. Andy Laster, ISCD President, provided a wonderful overview of Osteoporosis and Dr. Brian Sabowitz, Public Policy Chair, provided a more personal perspective of a primary care physician that has been forced to stop practicing. Mrs. Mary Bianco also addressed the group and provided her own experience as a patient who had been undiagnosed and is now living with osteoporosis.

Our meetings on the Hill were very successful and the number of sponsors in the House has already grown to 99 following our visits and 13 in the Senate.

We cannot emphasize enough the impact of your calls and e-mails to Congress. Congressional members want to hear from constituents on the importance of restoring funding for DXA testing. Please visit the ISCD Advocacy Web site for more information on how to contact your members of Congress.

DXA Days in DC Scheduled in June

On June 9th and 10th, ISCD members, along with supporters from AACE, NOF and a  growing list of over 30 partners, will hit Washington, DC in support of the DXA bills, S. 769 and HR. 1894. View the list of organizations that have signed a letter urging Congress to pass the DXA legislation. Given the pace at which Congress is considering health care reform, the timing of these Congressional visits is critical. ISCD members and other DXA supporters from key states will meet with their Congressional delegations and participate in a variety of activities including a Capitol Hill Reception/Educational Forum and a Capitol Hill Educational Briefing. All of the events are aimed at highlighting the need to include a remedy for the DXA cuts in any health care reform bill.

Your efforts are making a difference in Washington. In the past two months,  ISCD members have generated over 3,200 e-mails to members of Congress on the DXA bills. We are well on our way with over 80 co-sponsors on the bill in the House and 8 co-sponsors in the Senate. We continue to need your help. Over the next two weeks, we will ask our members in key states to help by making a call or sending an e-mail. You can pave the way for our Congressional visits by calling or e-mailing your delegation before we arrive in DC.  Even if you have already sent an e-mail, click here and send another or make a call.

Your stories about how the DXA cuts have affected your practice and your patients have been a very powerful tool and will be distributed at the Capitol Hill Briefing. It is important for us to put a  human face on the DXA cuts.  If you have a story to tell or a willing patient that will describe how their access to DXA services has been impaired, please e-mail Donna Fiorentino at dfiorentino@iscd.org.  If you plan to be in Washington over June 9th or 10th, please contact  Donna Fiorentino if you are interested in attending the briefings or participating in the hill visits.

DXA Bills Introduced in the House and Senate
The momentum is building…on April 1, 2009 Senators Blanche Lincoln (D-AR) and Olympia Snowe (R-ME) filed a bill to address the DXA cuts. (S.769 Medicare Fracture Prevention and Osteoporosis Testing Act). In the House, Representative Shelley Berkley (D-1st-NV)) and Representative Michael Burgess (R-26th-TX) introduced companion legislation H.R. 1894. These bills would return reimbursement for DXA to 2006 levels or $140. Click here for a copy of the legislation, Dear Colleagues (letters sent by the bill sponsors to their colleagues asking them to co-sponsor the bills), and a list of the original co-sponsors of the legislation.

We are well positioned in this session of Congress. The administration and Congressional leaders are focusing on disease prevention as a major part of any healthcare reform initiative.  Osteoporosis and DXA testing are the perfect model for disease prevention. Osteoporosis is associated with significant morbidity and mortality, has reached epidemic proportions making screen methods cost effective and can be accurately diagnosed and treated with FDA approved medications.  The DXA issue is striking a chord with policy makers who see disease prevention as an answer to many of the problems with the current healthcare system.

Our aggressive advocacy efforts will continue in upcoming months. We will need your help to convince as many members of Congress as possible to show their support for osteoporosis testing. By adding their names as co-sponsors to the DXA bills, we will show the widespread support for this issue. We will continue to enlist your help through membership wide e-mails or as we work district-by-district and state-by-state to gain the sponsorship of key members of Congress. We may call upon you  to send an updated  letter through our Advocacy Web site, to place a phone call to a Congressional aide or to help us locate patients who have been or will be affected by the cuts. We will also be coordinating our grassroots efforts with our partners at the American Association of Clinical Endocrinologists (AACE), American College of Rheumatology (ACRheum), The American Society for Bone and Mineral Research (ASBMR), National Osteoporosis Foundation (NOF) and The Endocrine Society (TES) as well as our industry partners.

Your contribution to our efforts remains critical. As always, your response in the past few weeks has been tremendous as ISCD members have sent almost 1,500 e-mails on the DXA bills to 84 Senators and 266 House members. Currently 6 Senators have sponsored the DXA bill and 69 House members have signed on as co-sponsors. Our goal in the House is to have 100 co-sponsors by Memorial Day.

If you can help with a particular member of Congress, have a story to tell about how a patient or you have been affected by the cuts, or have questions, please contact ISCD’s Legislative Counsel at dfiorentino@iscd.org.

State Advocacy Issues

During the summer and fall, ISCD has been working to increase the visibility and importance of quality DXA testing by profiling our certification and education programs in states all over the country.  Our goal is to work with our members and key state agencies to have ISCD Certification and education programs recognized in as many states as possible. Where opportunities arise, as the result of to some proposed change in statute or regulation, we will work with state regulators to determine how ISCD Certification and education programs may fit within a new regulatory scheme in that state. 

Our efforts to date have concentrated on Pennsylvania, New Jersey, North Carolina, Wisconsin, Kansas, Kentucky, Vermont, Delaware and Ohio. Specific details will be included in the Quarter 4, 2008 issue of our SCAN® newsletter (December 2008).  All ISCD members can access the current and past issues of SCAN by logging into the Members Only section of this Web site.

ISCD plans to continue these efforts initially states that do not regulate DXA technologists. These states include Idaho, Nevada, South Dakota, Oklahoma, Arkansas, Illinois, Michigan, Alabama, Maryland and New Hampshire.

ISCD Objects to Proposed Medicare Rule

On August 27, 2008 the ISCD filed comments on the latest Medicare proposed rule, CMS-1403-P. The rule included several provisions that threaten our ability to care for osteoporosis patients.  In addition to the administrative burden on physicians, the adoption of this proposed rule represents another assault on the availability of quality DXA.

The ISCD argued against the adoption of a new rule that would require physicians performing diagnostic imaging in their offices to enroll as an independent diagnostic testing facility (IDTF) and comply with certain standards in order to be eligible for reimbursement. The proposed rule in part focused on the qualifications for both physician and non-physician personnel performing these imaging procedures. CMS indicated that the impetus for this proposal was the result of comments by personnel at IDTFs who bristled under new requirements that only applied to imaging procedures performed in their facilities. They argued that regulations applying to imaging procedures should apply across the board regardless of where the location of physician performing it.

When implementing the rule on IDTFs, a majority of Medicare carriers require the supervising physician for DXA scans be limited to radiologists and/or internists. In addition, a majority of these carriers have not recognized the ISCD Certification of technologists.  We argued that the rule would exclude a substantial and highly skilled portion of the provider community.

ISCD also opposed the inadequate reimbursement rate for DXA and urged CMS to reevaluate the reimbursement for DXA to more accurately reflect the cost of providing the service. 

CMS Proposes New Rules Regarding Imaging Services in Physicians’ Offices.  Impact on DXA Testing is Unclear. 

On June 30, 2008 CMS proposed new rules that may have far-reaching implications for physicians providing diagnostic imaging services, including central DXA, to Medicare beneficiaries in their offices. CMS-1403-P would require physicians providing these services in a non-facility setting to comply with regulations that already apply to Independent Diagnostic Testing Facilities (IDTFs).1

The CMS proposed rule would require physicians performing diagnostic imaging services in their offices to:

It is unclear how this proposal would be interpreted by local Medicare carriers and how it would affect physicians and technologists providing DXA testing. Carriers have interpreted the IDTF regulations in a very restrictive manner by requiring that most imaging procedures be supervised by a radiologist. The proposed rule would also impose minimum standards on technologists if the imaging procedure is performed in a state that does not regulate radiologic technologists.

CMS has requested comments and feedback regarding this proposed rule.   The rule specifically requests comments by individuals and groups to respond to the following questions:

These questions make it clear that the parameters of the proposed rule have not yet been finalized. ISCD will submit comments to CMS on the proposed rule by the August 28 deadline and will keep you posted regarding its status.  As soon as ISCD has thoroughly analyzed the CMS proposal and developed our response, we will call upon our members to submit comments to CMS by the August 28 deadline. If you have questions or want to provide feedback on this issue, please contact ISCD Legislative Counsel, Donna Fiorentino.

Click here to view a relevant excerpt of CMS 1403-P.
Click here for the portion of the CMS regulations regarding IDTFs that would apply to diagnostic testing performed in physicians' offices.

A PowerPoint Overview - DXA Cuts

Click the link below to view or download a PowerPoint Overview of the DXA Cuts.  This document illustrates the problems created by the DXA cuts and the need to restore reimbursement to appropriate levels.  It can be used with local organizations and groups to generate participation in our grassroots advocacy campaign.

We Need Your Stories

As Congress returns from the holiday recess, ISCD and members of the DXA task force are continuing to press for a remedy to the DXA cuts. On February 25 and 26, ISCD will join AACE in Washington to visit key members of Congress to urge passage of Representative Berkley’s bill, H.R. 4206, the Medicare Fracture Prevention and Osteoporosis Testing Act of 2007 in the House and a companion bill in the Senate.

In the past year, ISCD and our partners have developed critical survey and statistical data to support our legislative position. While this information is imperative, we find that members of Congress are anxious to know how the cuts are affecting their constituents. You can help. We are collecting stories about practices who have already stopped DXA testing or have cut back services as the result of the Medicare cuts. An example of one such story from one of our Michigan members is listed below. If you have a story to tell, please contact Donna Fiorentino at dfiorentino@iscd.org.  

Visit the ISCD Advocacy Web site now, login (or register) and “Take Action” as an easy way to contact your Congressional Representative online.  It only takes a few minutes to help.

DXA Study Findings from The Lewin Group

ISCD, along with our sister societies, recently commissioned a study by The Lewin Group to determine the cost of performing a DXA and VFA procedure in the physician office setting. The study also looked at program costs associated with reversing Medicare payment cuts for these procedures. The Lewin Group study concluded that after accounting for savings assoicated with avoided fractures and the cost of treating at-risk individuals, restoring DXA payment rates to the 2006 level will ACTUALLY save the Medicare program $1.14 billion over five years.

Click here to read the executive summary or the complete report.  If you have questions, please contact Donna Fiorentino, Manager of Public Policy Affairs at dfiorentino@iscd.org. 

Related Articles

Below is a link to a compilation of articles related to Public Policy issues/efforts.

Final Support Letter

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