Endocrine Insider
August 15, 2007

Endocrine Society staff and members have been actively working to address the cuts to Medicare reimbursement for dual-energy X-ray absorptiometry (DXA) that went into effect on January 1, 2007, and much progress has been made. The cuts, if fully implemented in 2010, will reduce Medicare payment rates to physicians performing DXA scans in their offices from $140 in 2006 to $35 in 2010. The Society has been working in cooperation with the National Osteoporosis Foundation (NOF), American College of Rheumatology (ACR), American Association of Clinical Endocrinologists (AACE), and International Society for Clinical Densitometry (ISCD) to develop a comprehensive legislative, regulatory, and public relations campaign.

The Society and NOF have been working aggressively on behalf of the coalition to secure a sponsor for a DXA-specific fix to the payment cuts and have met with key House and Senate offices, including Sens. Lincoln (D-AR), Stabenow (D-MI), McCaskill (D-MO), Mikulski (D-MD), Snowe (R-ME), and Salazar (D-CO), and Reps. Berkley (D-NV) and Inslee (D-WA). The draft legislation developed by the working group asks for a halt to the payment cuts with a freeze at 2006 levels. During the freeze, the Institute of Medicine would conduct a study to analyze the impact of these cuts on patients’ access to DXA. While this draft language represents the best-case scenario for a fix, the sponsor of the bill may offer alternative language to address the cuts.

To refine our lobbying messages, the Society has also been working with the aforementioned societies to survey our memberships to measure the impact of the payment cuts on physicians’ ability to provide DXA services in their offices. The first survey, conducted in May, examined the intentions of physicians regarding their plans for providing DXA scans if the cuts are fully implemented. Of the 750 physicians who responded to the survey, 93 percent believe that they will no longer be able to provide DXA scans by 2010 at the rate of $35. The survey garnered additional insights into the thinking of physicians that will be used to emphasize the impact on patient access during future Hill visits.

The Society has also helped fund a study by the Lewin Group to measure the actual cost of providing DXA scans in the physician’s office and the cost to Medicare to freeze payments for DXA at 2006 levels. The survey was sent to 14,000 practicing physicians in the beginning of July, and data should be available by the end of August for use in our advocacy efforts.

Recently, Society member Carol Zapalowski, MD, of Denver, and staff participated in a briefing for women’s health organizations, held at NOF headquarters in Washington, DC. The purpose of the briefing was to inform these groups about the impact the DXA cuts are having on patients with osteoporosis and the physicians who care for them and to garner support for the coalition’s advocacy efforts, including support for legislation to halt the cuts to DXA reimbursement.

To generate additional support, the DXA working group will host a Webcast, in early October, to inform the healthcare community of the problem facing DXA providers and patients, highlight the efforts and achievements of the DXA working group, and gain the support of the community for our future activities.

While a great deal has been accomplished by the DXA working group, much work remains. The coalition members hope that the DXA-specific legislation will be introduced and voted upon during 2007, but with the current fiscal environment on Capitol Hill and other issues facing lawmakers this year, the legislation may not be considered until 2008.

For further information on the work of the Society to halt DXA payment cuts, please contact Stephanie Kutler, Associate Director of Government & Professional Affairs, at skutler@endo-society.org.