title: Effect of reimbursement reductions on bone mineral density testing for female Medicare beneficiaries.
abstract: BACKGROUND
  We examined whether the recent reimbursement reductions on the bone mineral density (BMD) test affected BMD testing in female Medicare beneficiaries with or without supplemental private health insurance.
  
  
  METHODS
  Retrospectively analyzing hospital administrative and clinical data on female Medicare beneficiaries (n=1320), we reviewed whether participants received BMD testing before (January 2004-December 2006) or after (January 2007-December 2009) reimbursement reductions for BMD testing. After adjusting for demographics and clinical characteristics, we performed Cox proportional hazard regression analyses of the BMD test including data from all study participants; we then performed separate regression analyses using data with or without supplemental private health insurance.
  
  
  RESULTS
  In those without supplemental private health insurance (n=421), less frequent BMD testing occurred after reimbursement reductions for BMD testing (hazard ratio [HR] 0.67, 95% confidence intervals [CI] 0.34-0.98; p=0.03). By contrast, in the overall participants (n=1320) and those with supplemental private health insurance (n=899), the number of BMD tests did not change significantly after reimbursement reductions for BMD testing.
  
  
  CONCLUSIONS
  We found a significant association between reimbursement reductions and decrease in BMD tests in female Medicare beneficiaries without supplemental private health insurance.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-2007, USA. yoojiw@trinity-health.org
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Yoo
authors.forename: Shunichi
authors.initials: S
authors.lastname: Nakagawa
authors.forename: Sulgi
authors.initials: S
authors.lastname: Kim
mesh_terms: D015502:Absorptiometry, Photon / Q000191:economics*; D015519:Bone Density; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D006278:Medicare / Q000191:economics*; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States