|
Bone
Densitometry for -Fee Per Scan |
Hard Look at Bone Densitometry Reimbursement Issues:How Unaccountable "Advisory" Committees Make It Easy for Medicare Medical Directors to Implement Short-Sighted Limitation of Coverage Payment Policies. Thankfully the Balanced Budget Act "transcends" the draconian bone density reimbursement limits imposed by some "vision challenged" state medical policy bureaucrats. This article explores why this federal action was necessary and how these closed door tribunals corrupt the health care delivery process by sacrificing good patient care all in the name of cost containment at any cost. Research has proven that low bone mineral density correlates with the risk for osteoporotic fractures better than blood glucose levels correlate with diabetes and blood cholesterol levels correlate with the risk of heart attack. In fact, on July 1st, 1998, the Balanced Budget Mandate of Preventative Care kicks in which requires HCFA reimbursement for bone density studies performed on high risk patients even if the test is negative. This visionary federal mandate of Preventative care for patients at risk of osteoporosis was passed into law after research made it clear, it was not only bad medicine to wait for patients to have a fracture before intervening, but it was also bad economics. Why was a federal mandate necessary to require HCFA reimbursement for bone density tests in all states, even if the test was negative? The answer is that the federal action was required to override the bizarre limitations of coverage policies imposed by some ill-advised state Medicare Medical Directors. In some states, Medicare and Medicaid will only pay for a bone density test if the person is determined to have osteoporosis, requiring physicians performing the tests on high risk individuals to eat the costs of tests performed on patients which turn out negative. This disincentive to identify patients at risk for fractures before they have the fracture, punishes doctors who want to avoid the malpractice risk of missing this invisible disease in these high risk patients. Many medical professionals feel it is indefensible and some would say unethical for a Medicare or a Medicaid patient to be told by the government they cannot have a diagnostic test performed on them paid for if the test is negative when the sole purpose of the test is to determine the patient has a disease such as osteoporosis. After all, in most cases, this is a silent and invisible disease with no symptoms except for high risk indications like ovarian dysfunction, estrogen deficiency and a perimenopausal state in female patients. Some Medical Directors have even gone so far as to deny coverage for a test on a patient who does not yet have osteoporosis but is in the early stages of bone loss thousands of women to having needless fractures that could have been prevented. The consequent suffering, misery, expense, burdens and oftentimes death which result from these fractures, many times are the result of these very narrow limitations of coverage policies. Health care providers should all hold Carrier Advisory Committee (CAC) members and the Medical Directors who implement their recommendations made in closed door meetings, responsible and accountable for their policies which directly cause so much suffering and death. These CAC's claim they always gather public input (usually very limited and impotent) before implementing their "new improved" limitations of coverage policies. However, our sad experience has shown that most of those affected don't have a chance to respond to proposed policies until it's too late or the narrow window for "input" has closed. How dare these people in their ivory tower tell the good doctors of their state that the burden is on the doctors to do free testing of high risk individuals who have this invisible disease? Is there any other profession that has to deal with such unfair policies, forcing them to work for free and only be paid some of the time for their hard work? How many patients are going to have fractures because their low bone mineral density is not identified? Obviously, the new federal policy to be implemented in July 1998, is based on the realization that it will save untold suffering and dollars to identify these patients at risk and prevent the first fracture. How many $30,000 hip replacement surgeries do we have to prevent to pay for the $150.00 bone density test and the drug therapy necessary to rebuild bones and prevent fractures in patients at risk? Some health care economists ask the question, "Where are we going to come up with the money to pay for all of this diagnostic testing to identify patients at risk for fractures?" Many would propose the answer lies in the money already now being spent for patients who have had fractures and their increased cost of care and reactive surgeries. Others point out that there is no way to put a cost on the loss of a loved one or the services and wisdom of our seniors. The truth is, the savings from avoided We should all applaud the many visionary Medical Directors in states around the country who have had the foresight to pay for bone density tests on high risk individuals, even if they turn out negative or osteopenic. These Medical Directors have said, "Sometimes the only symptom of the disease in patients is ovarian dysfunction or estrogen deficiency in a perimenopausal woman." Many claim testing these patients is absolutely not screening since estrogen deficiency is a symptom. Under normal circumstances, physicians cannot afford to test patients at risk for osteoporosis and only get paid for the tests performed on patients who turn out to actually have osteoporosis. If a physician chooses not to test patients with high risk factors because the physician cannot afford to get paid for only the positive studies performed, the physician then runs the risk of a malpractice suit if one of those non-studied high risk patients has a fracture a year or two later which could have been prevented had osteoporosis been identified and drug therapy implemented. Why are so many patients at risk for fractures not being identified? The answer lies at the feet of state Medicare Medical Directors who blame their narrow limitations of coverage decisions on unaccountable, mysteriously hidden CAC members who only want to pay physicians for bone density tests done on patients who turn out to have osteoporosis. It is eye opening to consider how many other hundreds of preventative diagnostic tests these "public servant" CAC's are discouraging and thereby sentencing patients to suffering and death all because of the misguided belief that it will save money to not identify patients at risk and let them have the fractures or other consequences of disease. (Does waiting to diagnose or intervene until after a patient has a fracture really cut costs?) Although help is on the horizon with the new federally mandated reimbursement policies to be implemented in July 1998, some CAC members and state Medicare Medical Directors have already expressed their intentions to attempt to sabotage these federally mandated preventative measures that will encourage physicians to do a better job identifying patients at risk for fractures before they have fractures. And why would they attempt this? All because their zero sum calculations do not take into account the money saved on prevented hip replacement surgeries and other increased patient care costs associated with patients' fractures. Their misguided belief that it will save money to allow patients to have these fractures and not be identified as "at risk" may be short sighted and ill-advised but it is passionately held by many of these powerful, unaccountable, CAC members and Directors. Right now, for bone densitometry, we would all be best to focus on making sure that the federal preventative care mandate to be implemented July 1, 1998, is not somehow subverted. On the broader issues of health care in general, we must all work to create a more just system that makes preventative- care available at least to high risk individuals before radical and invasive measures are required. After all, good preventative medicine doesn't cost, it pays when you look at the big picture. You'd think the policy makers would have learned this lesson already from the decades of radical, reactive," expensive and traumatic (physically and mentally) treatments and surgeries required for breast cancer victims before we woke up and budgeted the money for early diagnosis and intervention made possible by the mandated preventative care of regular mammograms. The fact that the risk of death from osteoporosis related complications is equal to the risk of death from breast cancer punctuates the similarities even more. Many believe that if we are to err on this issue, we should err on the side that saves lives, not on the side that kills people. Where do you stand? If you agree, disagree or would like to share your input with MEC/OBD, please call send an E-mail to info@bonedensitometry.com, or call 888-999-4774, send fax to 419-628-4005 |
|
 Message from the MEC/OBD
president:"As president, I have committed my company to providing medical facilities with "state-of-the-art" bone densitometry equipment to help them do a better job with preventing, testing for, screening for, detecting, diagnosing, and treating Osteoporosis which ravage so many women and men. Our diagnostic equipment will speed up the prevention, detection, diagnosis, and treatment of Osteoporosis and osteoporotic bone disorders in men and women. The key to preventing Osteoporosis in women and men is early detection, diagnosis, and treatment. This means measuring, testing, screening, detecting, and diagnosing low bone mass in women and men early in their lifetimes so that effective treatment can stop the Osteoporosis dead in its tracks." Together, we can help protect families from this terrible disease. Sincerely, |
MEC/OBD websites are managed by Online Design & Technology in accordance with MEC/OBD & Technology agreement #053198.