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 the Senate 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.
Last modified: December 27, 2012