Michael Kleerekoper, MD, MACE, has joined the faculty at the University of Toledo Medical School where he is Professor in the Department of Internal Medicine and section chief of the Endocrinology Division. The author of numerous journal studies, Dr. Kleerekoper serves on the editorial boards for Endocrine Today, Endocrine Practice, Journal of Clinical Densitometry, Journal of Women's Health, Osteoporosis International and Calcified Tissue International. Dr. Kleerekoper is also a founding board member of the newly formed Academy of Women’s Health.

Cutting DXA reimbursement won't improve the quality of the testing

For the second time in just a few years reimbursement for bone density testing has been reduced quite a bit. When that last happened only a few years ago, I posted a blog outlining the consequences of poorly done DXA studies.

Since that last reimbursement cut, I have noticed an ongoing decline in the quality of the reports that I receive. Let me quickly declare that I do not own or operate a bone densitometer, nor generate any revenue from DXA performed on my patients by others. My role is to help my patients understand what the DXA report is telling us and what the options for doing something (or nothing) might be.

This past week I received a bone density report indicating that a T-score of + 4.4 was normal!! I have requested that the study be re-analyzed but am still waiting for a reply. If the operator doesn’t know how/why the original report was wrong, they are unlikely to be able to correct it. You might not believe this, but the person signing off on the report did not even know what manufacturer’s instrument was being used.

I also got a report, from a different facility, that listed the area of L1 as 11.2 cm2, L2 as 12.6 cm2, L3 as 7.4 cm2, and L4 as 24.1 cm2!!  I can’t make this stuff up! Clearly the person preparing that report did not take the time to even look at the data.

Reimbursement for these studies will be the same as reimbursement for someone who knows what they are doing.

If you are not doing DXA studies yourself, I strongly recommend that you do not rely only on synopsis reports unless or until you are completely satisfied that the bone density tech and the colleague preparing the report know what they are doing. Since I don’t have a say where my patients go for DXA studies, I request that the report sent to me contains every speck of detail generated by the instrument and also contains the images. That request does not guarantee that the details have been looked at. The one scenario where I work hard at directing a patient to a particular bone density testing program is to ensure that serial studies are performed at the same testing center. Unless DXA instruments at different facilities have been cross-calibrated, serial data on different instruments is always suspect.

I know that the material in this blog contains nothing new for you but we need to get the message out to our non-endocrine colleagues, particularly those who perform the study but have not attended any formal training session. The last information I have been able to find is that only 25% of bone density technologists in Michigan have attended any training program.

In the interests of full disclosure, I suspect I have made at least one mistake this week.