A Preventable Disease... Not an Inevitable Result of Aging.
It wasn’t long ago that osteoporosis was looked upon as a “usual and customary” consequence of aging in older women. Today, based on advances in technology and healthcare practices, symptoms of the disease can be recognized – and treated – across the entire patient population.
Osteoporosis is defined as a systemic skeletal disease characterized by low bone mass and deterioration of bone tissue. Left untreated, the disease can progress and substantially increase bone fragility resulting in increased risk of bone fracture. Any bone can be affected, but fractures of the hip are of special concern.1 A hip fracture usually requires hospitalization and surgery. It can lead to on-going health problems that affect a patient’s lifestyle, including the ability to walk unassisted. Hip fractures may also result in prolonged or permanent disability, or even death. Evidence of disease prevalence can be charted for both sexes. (Table 1.)
Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity. The diagnosis of osteoporosis is not based on the demonstration of hip or spinal fracture, which is a complication or clinical expression of the disease, but on parameters capable of reliably predicting the risk of fracture.2
Major Threat to Health
According to the National Osteoporosis Foundation (NOF), the disease is a major health threat. As the population ages, the condition is reaching epidemic proportions. (See Table 2.) Each year, osteoporosis is responsible for more than 700,000 vertebral fractures and more than 300,000 hip fractures, with direct costs exceeding $18 billion per year. Women over the age of 50 have a fifty-percent chance of sustaining an osteoporotic fracture in their lifetime. Approximately one in four men will experience an osteoporosis-related fracture during his lifetime.3
Although osteoporosis has been diagnosed across virtually all patient demographics, specific populations are at risk. They include:
• All men and women age 60 and over, regardless of risk factors
• Younger postmenopausal women with 1 or more risk factors, other than
being caucasian, postmenopausal, and female
• Adults with a fragility fracture
• Adult with a disease or condition associated with low bone mass or bone loss 1, 4
Osteoporosis is a preventable disease, not an inevitable part of the aging process. Unfortunately, many patients are asymptomatic until bone loss is advanced and one or more fractures have occurred. Patients who have a hip fracture have 10 percent to 20 percent mortality in the first year, and fewer than 50 percent of patients are able to regain their prefracture level of mobility and independence. Prevention of osteoporotic fractures through early screening, diagnosis, intervention and monitoring is extremely important.3
Osteoporosis is at epidemic proportions, and most of those at risk have never been tested or diagnosed. The continual, growing need for BMD testing creates opportunities for your practice.
Under Tested. Although Medicare’s Bone Mass Measurement Act of 1998 mandates reimbursement for those patients who qualify with at least one of five risk indicators, BMD testing has only been performed on less than 1/3 of the qualified patient population.1
Increasing Demand. When the number of current qualified patient is combined with the population that has not been tested, taking into consideration the exponential growth of aging baby boomers that want to maintain their active lifestyles, you will continue to see an increased demand for BMD testing.
Brewing Storm. Physicians that we have recently spoken with said that their practice costs are rising, their profitability is shrinking, and they work harder to maintain the status quo.
New Strategies. They believe that the difference between future success and failure is the need to embrace a new business paradigm with differentiating strategies. Their new tactics include increasing their service repertoire, creating value-added patient services and diversifying their revenue.
Best Answer. Adding ancillaries is one of the best differentiating strategies. They not only enhance the quality of patient care and patient satisfaction, but also increase practice profitability to help offset the burden of rising practice costs.
Profit Center or Cost Center? What is your practice doing for you on your day off? When you’re doing rounds? BMD testing is one of the best ancillary services you can add to your practice. It has one of the highest reimbursement rates, has the highest reimbursement rate per unit of time (compared to other 15-minute procedures), and does not require a physician to be present during the procedure.
Optimal Timing. It’s a great time to become involved in bone mineral density testing! Only 16% of early adopting physicians have BMD capabilities in their practices.
Diagnose with Bone Mineral Densitometry
In evidence-based practice protocol, the measurement of a patient’s bone mass is the most expedient way to diagnose osteoporosis. Dual x-ray absorptiometry (DXA) scanning has been validated for this measurement. DXA provides bone mineral density (BMD) values and can aid the clinician in:
• Detecting osteoporosis before a fracture occurs
• Predicting the probability of a future fracture
• Measuring the rate of bone loss in the patient
• Monitoring the effects of osteoporosis treatment
BMD has become a primary indicator of overall patient health and many physicians have incorporated on-site DXA screening into their primary care practice. After evaluation of the patient’s history, a physical exam and risk factor assessment, these physicians determine whether BMD testing is appropriate and use the measured values to make an immediate assessment of their patients.
Benefits for both the Patient and the Physician
On-site BMD capability has a positive impact on patients by raising the level of healthcare quality. Immediate, on-site diagnosis leads to faster time to treatment while emphasizing patient convenience and comfort. For the physician, adding BMD scanning to the suite of on-site services can provide the financial incentives that help to offset the burden of rising practice expenses. For example:
• BMD has a higher reimbursement rate than most ancillary services
• BMD has a higher reimbursement rate per unit of time when compared to other procedures of similar length (14 minutes)
• BMD does not require the physician to be present during the procedure
Although Medicare reimbursements vary state by state, the agency generally allows reimbursement for a single BMD test every two years. It averages $82, depending on physician ownership of the scanning technology and the specific use of CPT codes. Medical necessity of the patient provides Medicare coverage for more frequent BMD monitoring. The International Society for Clinical Densitometry (ISCD) lists guidelines for reimbursements. Visit their website, www. iscd.org for more information.
The financial impact from on-site BMD screening to the revenue stream is immediate. Based on specific lease vs. purchase figures and the configuration of the BMD unit, approximately 15 scans a month is the break-even point. Twenty or more scans a month create a profitable investment.
BMD Technology in Practice
Chuck Powell, Director of Women’s Healthcare, at Emory Dunwoody Medical Center, told us about his experience with bringing BMD screening into their office. “Bone densitometry is complementary to our existing services and offers a great opportunity to do outreach in the community," commented Powell, “and we're always looking for additional profitable services to utilize the technologists we already employ.”
The impact of osteoporosis affects the patient, their family and their healthcare provider. It is estimated that 180,000 seniors will be forced into nursing homes, 800,000 will receive treatment in emergency departments and 300,000 will be hospitalized annually.
Osteoporosis is preventable when diagnosed in pre-symptomatic early stages with the help of DXA technology. Early treatment can prevent additional bone loss and keep patients active and healthy.
As a physician, the challenge of monitoring your patients’ bone health can also be an opportunity. With an aging patient population, BMD screening will help improve a physician’s standard of care while providing additional revenue.
1. National Osteoporosis Foundation. www.nof.org.
2. Rizzoli R. The Measurement of Bone Mass. Postgraduate Training course in Reproductive Health/Chronic Disease. WHO Collaborating Center for the Prevention of Osteoporosis, Department of Internal Medicine, University Hospital, Geneva, Switzerland. www.gfmer.ch/Endo/Course2003/Bone_mass.htm
3. Lambing CL. Osteoporosis • Reducing Fracture Risk. CME Bulletin, American Academy of Family Physicians. Vol. 4, No. 5, October 2005.
4. International Society for Clinical Densitometry. www.iscd.org