Trends in Dual-Energy X-Ray Absorptiometry in the United States, 2000–2009

O’Malley, Cynthia D.; Johnston, Stephen S.; Lenhart, Gregory; Cherkowski, G.; Palmer, Liisa; Morgan, Sarah

doi:10.1016/j.jocd.2011.03.003

Cited by 23 publications

(25 citation statements)

References 17 publications

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“…In summary, our results are consistent with other studies that show similar rates of DXA orders among patients who received DXA orders without any risk factors that would indicate appropriate screening from current guidelines [8,9]. Insurance claims have typically been used to calculate overuse rates [13]. All-payer claims databases are valuable sources of data to study overuse trends and the effect of Choosing Wisely initiatives among large numbers of patients covered by various providers.…”

Section: Discussionsupporting

confidence: 89%

“…Specifically, more than 50 specialty societies have joined the initiative, and efforts to translate the recommendations into changes in practice are ongoing [4,11]. However, research on overuse measures needed to understand how best to implement Choosing Wisely is often limited to studies of regional variation or demographic factors, and does not address the impact of Choosing Wisely on appropriate care for people with clinical risk factors [1,[11][12][13].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Has Choosing Wisely® affected rates of dual-energy X-ray absorptiometry use?

Lasser¹,

Pfoh²,

Chang

et al. 2016

Osteoporos Int

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Has Choosing Wisely® affected rates of dual-energy X-ray absorptiometry use?

Lasser¹,

Pfoh²,

Chang

et al. 2016

Osteoporos Int

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“…Reimbursements for hospital-based testing were stable over this time frame [14]. These payment changes have been associated with a shift in testing from nonhospital to hospital settings and an overall slowing in the growth of DXA testing [14-16, 12]. The impact of these changes on health outcomes of patients is unclear [12].…”

Section: Introductionmentioning

confidence: 99%

Overuse of short-interval bone densitometry: assessing rates of low-value care

et al. 2014

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Summary We evaluated the prevalence and geographic variation of short-interval (repeated in under 2 years) dual-energy X-ray absorptiometry tests (DXAs) among Medicare beneficiaries. Short-interval DXA use varied across regions (coefficient of variation=0.64), and unlike other DXAs, rates decreased with payment cuts. Introduction The American College of Rheumatology, through the Choosing Wisely initiative, identified measuring bone density more often than every 2 years as care “physicians and patients should question.” We measured the prevalence and described the geographic variation of short-interval (repeated in under 2 years) DXAs among Medicare beneficiaries and estimated the cost of this testing and its responsiveness to payment change. Methods Using 100 % Medicare claims data, 2006–2011, we identified DXAs and short-interval DXAs for female Medicare beneficiaries over age 66. We determined the population rate of DXAs and short-interval DXAs, as well as Medicare spending on short-interval DXAs, nationally and by hospital referral region (HRR). Results DXA use was stable 2008–2011 (12.4 to 11.5 DXAs per 100 women). DXA use varied across HRRs: in 2011, overall DXA use ranged from 6.3 to 23.0 per 100 women (coefficient of variation = 0.18), and short-interval DXAs ranged from 0.3 to 8.0 per 100 women (coefficient of variation=0.64). Short-interval DXA use fluctuated substantially with payment changes; other DXAs did not. Short-interval DXAs, which represented 10.1 % of all DXAs, cost Medicare approximately US$16 million in 2011. Conclusions One out of ten DXAs was administered in a time frame shorter than recommended and at a substantial cost to Medicare. DXA use varied across regions. Short-interval DXA use was responsive to reimbursement changes, suggesting carefully designed policy and payment reform may reduce this care identified by rheumatologists as low value.

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“…(6, 11, 12) In patients with commercial insurance, decreases between 2005 and 2008 were reported for patients with Medicare Supplementary Insurance and increases between 2000 and 2009 for commercially insured patients less than age 64. (13, 14) Overall, and based on these reports that describe a diverse population including Medicare and/or commercially insured patients and covering time periods wherein reimbursement cuts were being phased in, DXA utilization appears to have slowed and in some reports slightly declined.…”

mentioning

confidence: 99%

DXA Utilization Between 2006 and 2012 in Commercially Insured Younger Postmenopausal Women

Overman

Farley

Curtis

et al. 2015

Journal of Clinical Densitometry

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Introduction Reimbursement for dual energy x-ray absorptiometry (DXA) scans in the outpatient setting has declined significantly since 2006. Research through 2011 has suggested reimbursement reductions for DXA scans have corresponded with an overall decreased utilization of DXA. This study updates utilization estimates for DXAs through 2012 in patients with commercial insurance and compares DXA rates before and after reimbursement changes. Methods We evaluated DXA utilization for women age 50–64 from Marketscan Commercial Claims and Encounter database between January 2006 and December 2012 based on CPT codes. We estimated utilization rates per 1,000 person years. We also employed segmented regression analysis of monthly rates to evaluate the change in utilization rates after a proposed reimbursement reduction in July 2009. Results In women aged 50–64; 451,656 DXAs were performed in 2006, a rate of 144 DXAs per 1,000 person years. This rate increased to 149 DXAs per 1,000 person years in 2009 before decreasing to 110 DXAs per 1,000 person years or 667,982 scans in 2012. DXA utilization increased by 2.24 per 1,000 person years until July 2009 then declined by 12.98 DXAs per 1,000 persons, resulting in 37.5 DXAs per person year fewer performed in 2012 compared to 2006. Conclusion Since July 2009 a significant decline in DXA utilization occurred in a younger postmenopausal commercially insured population. This decline corresponds with a time period of reductions in Medicare DXA reimbursement.

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Trends in Dual-Energy X-Ray Absorptiometry in the United States, 2000–2009

Cited by 23 publications

References 17 publications

Has Choosing Wisely® affected rates of dual-energy X-ray absorptiometry use?

Has Choosing Wisely® affected rates of dual-energy X-ray absorptiometry use?

Overuse of short-interval bone densitometry: assessing rates of low-value care

DXA Utilization Between 2006 and 2012 in Commercially Insured Younger Postmenopausal Women

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