Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
J Bone Miner Res. 2012 Apr;27(4):858-64. doi: 10.1002/jbmr.1534.
In the United States, Medicare gradually reduced payments for central dual-energy X-ray absorptiometry (DXA) performed at physician offices (or other nonhospital settings) from an average of $139 in 2006 to about $82 in 2007 and 2008 and $72 in 2009. Reimbursement for hospital outpatient DXA service was unchanged. We investigated the utilization of hip and spine (central) DXA in the Medicare population before and after the reduction. We identified individuals from the national 5% random sample of Medicare beneficiaries who were ≥65 years of age and enrolled in Medicare Parts A and B but not in a Medicare Advantage plan from 2002 through 2009. For each calendar year, we calculated the proportion of beneficiaries who submitted claims for DXA, the proportions of DXAs performed in hospitals and in physician offices and the number of physician office-based practices that discontinued or started to provide DXA services. From 2002 to 2006, the proportion of beneficiaries who had at least one central DXA increased from 7.9% to 9.6% at an annual increase of 0.4% and from 2006 to 2009, the annual increase dropped to 0.1%. The number of DXAs performed in physician offices dropped from 1,643,720 (69% of 2,363,500 total DXAs) in 2006 to 1,534,240 (66% of 2,338,240) in 2009. This decline was offset by an increase in the number of DXAs performed in hospitals, which increased from 719,780 (31%) in 2006 to 804,000 (34%) in 2009. Among physician office-based practices, more practices initiated than discontinued DXA service each year from 2002 to 2006. However, the trend was reversed since 2007 such that in 2009, 1876 practices discontinued and only 1394 initiated DXA service. The reduction in DXA reimbursement was associated with a decrease in the number of DXAs performed in physician offices and fewer physician offices that provided DXA services.
在美国，医疗保险逐渐降低了在医生办公室（或其他非医院环境）进行的中央双能 X 射线吸收测定法（DXA）的支付费用，从 2006 年的平均 139 美元降至 2007 年和 2008 年的约 82 美元，2009 年降至 72 美元。对医院门诊 DXA 服务的报销保持不变。我们调查了医疗保险人群中髋关节和脊柱（中央）DXA 的使用情况，该调查在降低支付费用之前和之后进行。我们从 2002 年至 2009 年，从全国 5%的医疗保险受益人的随机样本中确定了年龄在 65 岁及以上、参加医疗保险 A 部分和 B 部分但未参加医疗保险优势计划的个人。对于每个日历年，我们计算了提出 DXA 索赔的受益人的比例、在医院和医生办公室进行的 DXA 的比例以及停止或开始提供 DXA 服务的医生办公室数量。从 2002 年到 2006 年，至少进行一次中央 DXA 的受益人的比例从 7.9%增加到 9.6%，年增长率为 0.4%，而从 2006 年到 2009 年，年增长率下降到 0.1%。在医生办公室进行的 DXA 数量从 2006 年的 1643720（2363500 次总 DXA 的 69%）减少到 2009 年的 1534240（2338240 次的 66%）。这一下降被医院进行的 DXA 数量的增加所抵消，从 2006 年的 719780（31%）增加到 2009 年的 804000（34%）。在医生办公室基础实践中，从 2002 年到 2006 年，每年开始 DXA 服务的实践多于停止的实践。然而，自 2007 年以来，这种趋势发生了逆转，因此在 2009 年，有 1876 个实践停止了 DXA 服务，而只有 1394 个实践开始了 DXA 服务。DXA 报销的减少与医生办公室进行的 DXA 数量减少以及提供 DXA 服务的医生办公室数量减少有关。
