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.