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.
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.
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).
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.
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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This study was supported by grants from the National Institute on Aging (P01 AG019783 and K23 AG035030), the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization (HCFO) Initiative (#70729), and The Commonwealth Fund (#20130339). We are grateful to Kristen K. Bronner, M.A., of The Dartmouth Institute for Health Policy and Clinical Practice for assistance with mapping. Ms. Bronner received no compensation for this service.
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Morden, N.E., Schpero, W.L., Zaha, R. et al. Overuse of short-interval bone densitometry: assessing rates of low-value care. Osteoporos Int 25, 2307–2311 (2014). https://doi.org/10.1007/s00198-014-2725-2
- Bone densitometry
- Health services research