Osteoporosis-related hip fractures are no longer on a downward trend in the U.S. A drop in reimbursement for a common screening technique could be to blame.
E. Michael Lewieck M.D
The 15-year trend of decreasing hip fractures due to osteoporosis is coming to a close in the United States, according to an observational study of Medicare claims data. A drop in reimbursement for a common screening technique could be to blame.
Since 2001, hip fracture rates have dropped thanks to improvements in osteoporosis evaluation and fracture predictions via dual-energy X-Ray absorptiometry (DXA), as well as new drugs, such as oral bisphosphate. DXA uses to X-ray beams to measure bone mineral density and diagnose osteoporosis.
In a Sept. 17, presentation at the 2016 American Society of Bone Mineral Research conference, lead study author E. Michael Lewiecki, M.D., of the New Mexico Clinical Research and Osteoporosis Center, discussed investigators’ analysis of hip fracture rates to determine if the downward trend still existed.
Researchers used Medicare claims and enrollment data from 2002-2014, approximately 900,000 annually, for the analysis. It was five percent sample of Medicare’s fee-for-service beneficiaries who had at least one Medicare-paid DXA scan per year. DXA providers were either office-based, free-standing or hospital-based. Analysts identified hip fractures with ICD-9 codes 820.0x, 820.2x, and 820.8x, excluding trauma-associated fractures.
While the analysis showed a downward trend in osteoporosis-caused hip fractures from 2002-2012, the data revealed a reversal, beginning in 2013. The uptick coincides with a drop in Medicare reimbursement for DXA screening. Reimbursement levels dropped to below cost, Dr. Lewiecki said in an interview with Rheumatology Network.
“The analysis suggests the downward trend for hip fractures in the United States could be over,” he said. “We can’t say that declines in DXA reimbursement are directly responsible for the higher than expected hip fractures, but it makes sense when you look at other contributing factors.”
To combat the drop in screening and, potentially, provide better treatment for osteoporosis, Dr. Lewiecki said patients should educate themselves about the benefits and risk of DXA screening. In addition, he said, patients and providers should support a bill in the U.S. Congress that would create a reimbursement floor for DXA payments that would make providing screening more profitable – or at least less costly – for doctors who have offered the service.
Dr. Lewiecki has received funding from Eli Lilly, Amgen, Merck, Shire and Radius Health.
Abstract 1077: “Hip Fractures and Declining DXA Testing: At a Breaking Point?,” E. Michael Lewiecki, M.D.” Sept. 17, 2016.