Osteoporosis Care in the United States After Declines in Reimbursements for DXA
Osteoporosis Care in the United States After Declines in Reimbursements for DXA
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DOI：
10.1016/j.jocd.2010.08.001
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发表时间：
2010-10-01
影响因子：
2.5
通讯作者：
Carbone, Laura D.
中科院分区：
文献类型：
--
作者：
Hayes, Burton L.;Curtis, Jeffrey R.;Carbone, Laura D.
2007年1月，在美国，联邦医疗保险开始削减在非医疗机构进行的双能x射线吸收测量（DXA）服务的报销，到2010年1月，与2006年水平相比，这些服务的支付减少了60%以上。本研究的目的是确定在医疗保险医师收费表中基于办公室的DXA报销的变化与骨质疏松教育会议的出席、医生对其医疗实践变化的看法或65岁及以上骨质疏松症零售处方药的全国趋势之间是否存在时间相关性。与DXA医保报销减少前2年（2005-2006年）相比，美国骨质疏松教育会议的出席率在这些削减后的2年（2007-2008年）下降了6%；出席率的下降只出现在骨密度测定的选择性会议上。调查参与者报告了DXA服务的变化，大约三分之一的人表示，与2005-2006年相比，他们要么减少了执行的DXA数量，要么拒绝了服务合同或硬件/软件更新。与2005-2006年相比，2007-2008年期间，美国食品和药物管理局批准的65岁及以上人群的骨质疏松症药物（不包括雌激素化合物和雷洛昔芬）的零售处方数量增加了5.5%。然而，在研究的最后一年（2008年），这些药物的零售处方总额在研究期间首次出现增长，与前一年相比下降（1.4%）。尽管美国65岁及以上的人口增加了2.6%。总之，在美国，参加骨密度测量教育会议的DXA支付的医疗保险削减、办公室提供DXA服务的自我报告和骨质疏松症治疗的零售处方之间存在时间关联。
In January 2007, in the United States (US), Medicare initiated a series of cuts to reimbursement for dual-energy X-ray absorptiometry (DXA) services performed in the nonfacility setting that by January 2010 reduced payments for these services by more than 60% compared with 2006 levels. The objectives of this study were to determine if a temporal association exists between Medicare Physician Fee Schedule changes in office-based DXA reimbursement and attendance at educational conferences for osteoporosis, physicians' perceptions of changes in their medical practices, or national trends in retail prescription medications for osteoporosis in those aged 65 and older.Compared with the 2 yr before the decline in Medicare reimbursement for DXA (2005-2006), attendance at educational meetings for osteoporosis in the US declined in the 2 yr after these cuts (2007-2008) by 6%; declines in attendance were only present in meetings selective for bone densitometry. Survey participants reported changes in DXA services with approximately one-third indicating that they had either decreased the number of DXAs they performed or declined service contracts or hardware/software updates compared with 2005-2006. The number of retail prescriptions for Food and Drug Administration approved osteoporosis drugs (excluding estrogen compounds and raloxifene) in the age 65 and older population increased by 5.5% in the time period 2007-2008 compared with 2005-2006. However, in the last year of the study (2008), total retail prescriptions for these drugs experienced for the first time over the interval of the study, a decline (1.4%) compared with the previous year. This occurred despite a 2.6% increase in the US population age 65 and older.In conclusion, there were temporal associations noted between Medicare cuts in DXA payments in attendance at educational conferences for bone densitometry, self-report of office-based provision of DXA services in the US, and retail prescriptions for osteoporosis therapies.