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AAOE Fights to Increase DXA Reimbursements

Thursday, May 30, 2019   (0 Comments)
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Washington, DC – In honor of National Osteoporosis Month, the American Alliance of Orthopaedic Executives (AAOE) is proud to announce its partnership with the Fracture Prevention Coalition to support legislation increasing the Medicare reimbursement rate for dual x-ray absorptiometry (DXA) tests performed in a physician’s office.

Approximately 54 million Americans have low bone mass and osteoporosis with one in two women and one in four men age 50 and older at risk of an osteoporotic fracture. This risk makes early detection of low bone density imperative. DXA testing is required by Medicare for the diagnosis and treatment of osteoporosis making fair reimbursement for these exams critical to ensuring that patients receive the timely care they need.

“AAOE strongly supports the work of the Fracture Prevention Coalition and we are excited to work with the coalition to advocate for fair reimbursement. Our members want to provide these exams to their patients, but current reimbursements make this very difficult for all but the largest orthopedic practices,” said AAOE Manager of Government Affairs, Bradley Coffey.

Since CMS changed the DXA reimbursement formula in 2007, there has been a marked decline in diagnoses and an alarming increase in the number of osteoporosis-related hip fractures. Approximately 25% of Americans who suffer a hip fracture will die within the first year after their fracture, and another 25% will never leave a nursing home, according to the National Osteoporosis Foundation.

“Passage of this legislation will ultimately save lives and it’s inexcusable that Congress has waited this long to fix the reimbursement formula,” said AAOE President Kitchi Joyce of OrthoAtlanta. “We’re hopeful that Congress will end these worrying trends during the 116th Congress.”

Current national reimbursements for DXA scans performed in a physician’s office average around $40 per scan. The legislation supported by AAOE and the Fracture Prevention Coalition would establish a reimbursement floor in the Medicare statute for DXA tests of $98. This floor was determined by interviews with physicians who determined that $98 reimbursements would allow practices to cover the costs of providing these tests to patients. The legislation was sponsored in the House by John Larson (D-CT), Linda Sanchez (D-CA), Jackie Walorski (R-IN), and Susan Brooks (R-IN), and in the Senate by Susan Collins (R-ME) and Ben Cardin (D-MD). The bills are numbered HR 2693 in the House and S 283 in the Senate.


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