Effect of medicare reimbursement reduction for imaging services on osteoporosis screening rates

Objectives To determine bone mineral density (BMD) testing rates and the proportion of women diagnosed after BMD screening vs an osteoporosis-related fracture before and after reductions in Medicare reimbursement for office-based imaging services in 2007, which was projected to save $2.8B over 5 years. Design Retrospective observational analysis of administrative medical claims reimbursement data. Setting Analysis of data from a medical claims data set. Participants A cohort of 405,093 women (average age 74.1 ± 6.7) aged 65 and older with employer-sponsored Medicare supplemental coverage. Measurements BMD testing and the incidence of participants whose first diagnosis for osteoporosis occurred with BMD screening vs as a result of osteoporosis-related fracture were identified by calendar year. Results Thirty-eight percent of participants received one or more BMD tests during the study period. The proportion of women who received a BMD test was 12.9% in 2005, 11.4% in 2006, 11.8% in 2007, and 11.6% in 2008. Although testing rates varied, results were consistent with testing guidelines and did not decrease at a rate relative to reimbursement reductions, as had been anticipated. Conclusion BMD screening rates did not substantially decline in Medicare-eligible women in the 2 years after reimbursement reductions. Meanwhile, the proportion of women diagnosed after a fracture increased, although the nature of this increase is unclear.