Densitometry funding again promoted on Hill

May 8, 1991

Congress may consider legislation this session calling for Medicarereimbursement of bone densitometry procedures. Sponsors of theMedicare Bone Mass Measurement Coverage Act of 1991 and a companionosteoporosis research bill face an uphill battle, however,

Congress may consider legislation this session calling for Medicarereimbursement of bone densitometry procedures. Sponsors of theMedicare Bone Mass Measurement Coverage Act of 1991 and a companionosteoporosis research bill face an uphill battle, however, aspressure grows to keep a lid on Medicare expenditures.

Rep. Olympia Snowe (R-ME) and Sen. John Glenn (D-OH) introducedthe reimbursement bill last year, but it did not reach a vote.They reintroduced the legislation in February.

Legislation authorizing reimbursement of densitometry exams--evenat $50 each--could raise Medicare costs by billions of dollars.That may be a hard pill for Congress to swallow, given the politicalreaction against rising health-care costs, said Joel B. Weinstein,vice president of marketing for Hologic, a densitometry vendor(see story, page 2).

"I don't see that this is the year people are ready tospend $7 billion more on medical reimbursement," he said.

The number of congressional sponsors of the legislation hasincreased this year, however, which is a positive sign, he said.

Even if Congress authorizes reimbursement of densitometry exams,there is no assurance that the medical community will enthusiasticallyadopt the procedures, said Joel Blank, vice president of marketingfor Norland of Fort Atkinson, WI.

"Reimbursement is a bit of a red herring. It is a result,not a cause--a result of the fact that there are a limited numberof (osteoporosis) therapies available in this country and a lackof consensus in the medical community," he said.

The National Osteoporosis Foundation and other supporters ofosteoporosis prevention and treatment are making headway in educatingdoctors, however. Attendance at conferences focusing on osteoporosisis increasing, he said.

There is also a good chance that a report due in July fromthe Office of Technology Assessment (OTA), an advisory body toCongress, may provide a favorable review of dual-energy x-rayabsorptiometry (DEXA) and other bone densitometry technologies,Weinstein said.

BRIEFLY NOTED:

  • The Health Care Financing Administration (HCFA) is closeto signing off on regulations instituting cost-effectiveness asa criterion for Medicare reimbursement, according to a reportin the New York Times. The agency confirmed that these regulationsare being finalized, but would not provide an expected date ofcompletion.

HCFA first proposed the use of cost-effectiveness as part ofa "reasonable and necessary" criterion for reimbursementover two years ago (SCAN 3/15/89).