Dual-energy x-ray absorptiometry (DXA or DEXA) to assess bone mineral density is hardly new, but DXA testing has been discounted in recent years as an unaffordable practice option for most primary care physicians. Even through the roller coaster of reimbursement rates over the past 5 years, many practices have continued to find DXA scans beneficial to their patients and their profitability. Newer technology and dropping prices may make it feasible for more practices, even with uncertainty about future reimbursement rates.
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In the early part of this decade, the $80,000 price tag of flatbed densitometers kept many doctors from bringing bone density scans in-house. Those who did, however, saw rapidly increasing reimbursement rates for whole body scans, peaking in 2006 at $139 per test, on average.
The Patient Protection and Affordable Care Act restored rates to a national average of $98 in 2010 (retroactively) and 2011 and eliminated the patient cost-sharing component for Medicare beneficiaries.
In February, the U.S. House of Representatives and the U.S. Senate passed the Middle Class Tax Relief and Job Creation Act of 2011, which eliminated a provision that would have increased payments for DXA testing. As a result, reimbursement rates dropped to $56 as of March 1. With the Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011 currently in committee in both the House (H.R. 2020) and Senate (S. 1096), the next best chance for the restoration of higher rates will be in January when Congress re-examines the sustainable growth rate cuts.
The prospect of lower reimbursement rates clearly makes DXA scanning less attractive, but even at the nadir of reimbursement, some practices have found that it makes sense. With reimbursement rates low and projected to fall further, Sheridan Medical Group in Tonawanda, New York, decided to add DXA scanning in 2009.
"We were looking for ways to augment the practice consistent with what we already did. We determined that DXA scans would help us reduce overall morbidity and mortality in our patients, who tend to be older," says Richard A. Carlson Jr., MD.
"Of course, there's some risk with any new venture; we were willing to take that risk," adds Rajiv Jain, MD.
Jain's involvement in sports medicine gives the practice an additional group of patients who can benefit from the scan: athletes. Bone health is critical for anyone serious about sports participation. Monitoring body fat also is a concern. DXA scans enable practitioners and patients to track changes in both measures.
Medicare and most commercial insurers will not pay for scans for body fat analysis. But "it's an indicator that's useful for assessing overall health" for athletes and others trying to get in better shape, Jain says.