title: Consultative DXA reporting improves guideline-driven quality of care-implications for increasing DXA reimbursement.
abstract: Since 2001, Geisinger Health System densitometrists have interpreted dual-energy X-ray absorptiometries (DXAs) in a guideline-driven, consultative fashion. We believe that this approach results in more patients receiving appropriate treatment. Recently, one of our DXA centers chose to stop consultative reporting, providing us an opportunity to review the care rendered with 2 different styles of DXA reporting formats: Consultative vs Results Only. In this retrospective chart review, 100 consecutive DXAs with Consultative reporting and 100 consecutive DXAs with Results Only reporting were identified. The electronic health record was reviewed for a 3-mo interval after DXA result to identify whether a prescription medication was prescribed per system guidelines. Logistic regression compared the proportion of patients receiving a prescription treatment between the 2 groups. The Consultative report group received more prescription treatment compared with Results Only format (72% vs 50%) after controlling for patients' age and gender, odds ratio=2.64, 95% confidence interval=1.45-4.79 (p=0.0014). Our study demonstrates that Consultative DXA reporting results in better care. Importantly, Consultative reporting takes additional time; yet, reimbursement for these efforts and expertise has been dramatically reduced. To appropriately reward the value of DXA testing and interpretation, Consultative reporting should be reimbursed at the previous higher reimbursement rate.
authors.affiliation: Department of Rheumatology, Geisinger Health System, Danville & State College, PA, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Oppermann
authors.forename: William
authors.initials: W
authors.lastname: Ayoub
authors.forename: Eric
authors.initials: E
authors.lastname: Newman
authors.forename: G Craig
authors.initials: GC
authors.lastname: Wood
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Olenginski
mesh_terms: D015502:Absorptiometry, Photon / Q000191:economics* / Q000706:statistics & numerical data; D000368:Aged; D004282:Documentation / Q000191:economics; D004363:Drug Utilization; D057286:Electronic Health Records; D005260:Female; D019983:Guideline Adherence / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D010414:Pennsylvania; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics; D011787:Quality of Health Care / Q000191:economics*; D012017:Referral and Consultation; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies