DXA Reimbursement Slated to Plummet March 1


Medicare payments for the use of dual energy x-ray absorptiometry are set to drop on March 1 unless Congress acts to extend the current payment rates for the screening procedure.

Physicians performing dual energy x-ray absorptiometry (DXA) testing currently are reimbursed at around $100 per test on average, but those payments are scheduled to drop to about $50 without congressional intervention. Physicians also are concerned that the steep cut could force more office-based physicians to stop offering bone density screening, thereby limiting access for patients.

"We will definitely be changing the way that we do business when it comes to DXA," said Dr. Christopher R. Shuhart, a family physician and medical director for bone health and osteoporosis at Swedish Medical Group in Seattle.

The large multispecialty group is considering a range of options, including whether to limit the number of sites where they offer DXA testing, in part because of the potential Medicare fee cut. They had already been considering changes to their DXA practice for other reasons, Dr. Shuhart said, but the financial pressure that would come with a cut to $50 per test is a significant factor.

"DXA is both clinically valuable and cost effective."

Dr. Shuhart, who also is cochair for facility accreditation at the International Society for Clinical Densitometry (ISCD), said that Swedish Medical Group is in a better position to absorb the DXA cuts than most small private practices because they are part of a large health care system, which allows them to benefit from higher private insurance contract rates that help to offset cuts in Medicare payments.

Congress first cut DXA payments in 2007, when it slashed Medicare payments for imaging services as part of the Deficit Reduction Act of 2005. Although DXA wasn’t one of the high-cost imaging modalities lawmakers had in their crosshairs, it still was included in the law.

Physicians took another payment hit when the Centers for Medicare and Medicaid Services reduced payments for physician work involved in interpreting the results of a DXA test. The cuts were phased in over time, but by the beginning of 2010, the average Medicare payment for DXA had dropped from a high of about $140 to about $62.

Under the Affordable Care Act, DXA payments were restored to 70% of the 2006 level, bringing them back up to nearly $100. But that increase was only for 2 years. At the end of last year, the increase was scheduled to expire, when Congress granted a 2-month reprieve by including DXA in the Temporary Payroll Tax Cut Continuation Act of 2011, which also extended the 2011 Medicare physician fee schedule rates, the payroll tax holiday, and federal unemployment benefits temporarily.

What will happen next with DXA payment is uncertain and depends in large part on the fate of the larger legislative package currently under consideration in Congress.

"It looks like the [Medicare Sustainable Growth Rate formula], DXA, and payroll taxes are wrapped up together for at least the immediate future," said Dr. Jonathan D. Leffert, an endocrinologist in Dallas and chair of the Legislative and Regulatory Committee for the American Association of Clinical Endocrinologists.

Dr. Leffert said that a permanent stabilization of DXA payment rates is not likely right now and that an extension of the current payment rates could range anywhere from 2 months to 22 months. "At this point, it’s pretty much not about the policy, but about the money," he said. Specifically, lawmakers are struggling to find ways to pay for not only the increased DXA payments to physicians but a temporary fix for the 27% Medicare physician fee cut that is also slated to take effect on March 1.

But just getting lawmakers to include DXA in the Temporary Payroll Tax Cut Continuation Act was a big step, said Dr. Andrew J. Laster, a rheumatologist in private practice in Charlotte, N.C., and chair of the public policy committee for the ISCD. There were only about a dozen health provisions that made it into that bill, so it shows that Congress recognizes the value of identifying people with osteoporosis and treating them. "Now at least we are in the room and acknowledged," he said.

"We will definitely be changing the way that we do business when it comes to DXA."

Dr. Laster added that he’s also encouraged by a recent study published in the journal Health Affairs that helps bolster the case for increasing payments for bone density testing (Health Aff. 2011;30:2362-70). Looking at a large population of Medicare beneficiaries, researchers found that as payments for DXA dropped, Medicare claims for the test plateaued. For instance, from 1996 through 2006, before the payment cuts went into effect, DXA testing was growing at a rate of about 6.5%. From 2007 through 2009, however, about 800,000 fewer tests were administered to Medicare beneficiaries than would have been expected based on the earlier growth rate.

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