From the July 2016 issue of HealthCare Business News magazine
In 2010, Medicare paid $18.7 billion for direct costs of new fractures, and this number is projected to grow to over $25 billion per year by 2025. The cost to fix just one hip fracture is roughly $30,000 to $40,000, and a study published in Mayo Clinic Proceedings shows that the hospital burden of osteoporotic fractures and hospital cost is greater than that of myocardial infarction, stroke or breast cancer. In comparison, the cost of more appropriately covering routine DXA scans for patients before a fracture occurs is minimal.
This is why a bill working its way through Congress is so important. House Bill 2461, The Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2015, helps physician offices and freestanding imaging centers get appropriate and necessary reimbursement for these screenings to determine who is at the highest risk for bone loss in order to prevent a fracture before it occurs.
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If passed, HR 2461 would establish a minimum payment of $98 per patient for DXA tests under Medicare Part B. This is the rate established by Congress in 2010 — when payment relief was provided due to the noticeable drops in reimbursement rates — and is also in line with the reimbursements covered under Medicare Part B for hospital outpatient departments. A net savings of $1.2 billion is estimated in the Act, and that does not even account for the pain and suffering it could save patients.
While we have no assurance Congress will take action on HR 2461, it has been made abundantly clear to our government that a problem exists and it needs to be resolved sooner, rather than later. Even the most cynical staffers would agree that this reimbursement incongruence problem is huge and HR 2461 is most definitely critical in its resolution. We need to work together now to identify those at risk of osteoporosis in order to save money, and future pain and suffering.
About the author: Dr. Robert F. Gagel serves as professor, Department of Endocrine Neoplasia & Hormonal Disorders, University of Texas MD Anderson Cancer Center, and is the director of the Bone Disease Program of Texas, a collaborative program of Baylor College of Medicine, MD Anderson Cancer Center and University of Texas Health Science Center. He is also the immediate past president of the National Osteoporosis Foundation and immediate past co-chair of the National Bone Health Alliance.Back to HCB News
