title: DXA Utilization Between 2006 and 2012 in Commercially Insured Younger Postmenopausal Women.
abstract: Reimbursement for dual-energy X-ray absorptiometry (DXA) scans in the outpatient setting has declined significantly since 2006. Research through 2011 has suggested reimbursement reductions for DXA scans have corresponded with an overall decreased utilization of DXA. This study updates utilization estimates for DXAs through 2012 in patients with commercial insurance and compares DXA rates before and after reimbursement changes. We evaluated DXA utilization for women aged 50-64 yr from Marketscan Commercial Claims and Encounter database between January 2006 and December 2012 based on CPT codes. We estimated utilization rates per 1000 person years (PY). We also used segmented regression analysis of monthly rates to evaluate the change in utilization rates after a proposed reimbursement reduction in July 2009. In women aged 50-64 yr, 451,656 DXAs were performed in 2006, a rate of 144 DXAs per 1000 PY. This rate increased to 149 DXAs per 1000 PY in 2009 before decreasing to 110 DXAs per 1000 PY or 667,982 scans in 2012. DXA utilization increased by 2.24 per 1000 PY until July 2009 then declined by 12.98 DXAs per 1000 persons, resulting in 37.5 DXAs per PY fewer performed in 2012 compared with 2006. Since July 2009 a significant decline in DXA utilization occurred in a younger postmenopausal commercially insured population. This decline corresponds with a time period of reductions in Medicare DXA reimbursement.
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA; Department of Rheumatology, Orthopedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: overmar@unc.edu.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Overman
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Joel F
authors.initials: JF
authors.lastname: Farley
authors.affiliation: Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Gourlay
authors.affiliation: Department of Rheumatology, Orthopedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Chad L
authors.initials: CL
authors.lastname: Deal
mesh_terms: D015502:Absorptiometry, Photon / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging*; D012044:Regression Analysis; D012051:Reimbursement Mechanisms; D014481:United States
keywords: Dual energy x-ray absorptiometry (DXA); osteoporosis; reimbursement; utilization