Rural residents depend on physician offices for their osteoporosis testing
Research Activities, February 2010, No. 354
Patients suspected of having osteoporosis typically are measured for bone mass with central dual-energy X-ray absorptiometry (DXA). However, fewer than one-third of older women and 5 percent of older men get this testing. Making it more available is important. However, cuts in reimbursing DXA provided in physician offices or outpatient settings may reduce availability, particularly for rural residents, caution the authors of a new study. They found that travel distance was strongly associated with DXA testing and that rural residents heavily depended on having such testing available in physician offices.
The researchers identified claims submitted to Medicare for bone mass measurement during the period between 1999 and 2006. Information was obtained on the locations of facilities providing DXA testing and the patients receiving such testing. Travel distance was determined from the Medicare patient's residence to the nearest DXA provider.
During 2006, 2.9 million DXAs were performed, a 103 percent increase since 1999. From 2005 to 2006, 8 percent of individuals were tested at nonfacility sites, such as physician offices, compared with 4.2 percent of persons tested at facility sites, such as hospitals. The more miles required to travel to get tested, the lower the likelihood of actually receiving DXA testing. This was true even after the researchers controlled for such factors as patient age, sex, and other health conditions. Nonfacility DXA providers performed about two-thirds of DXA testing during the 8 years of the study. Based on travel distance, rural residents would have reduced access to testing if nonfacility providers were to stop performing the procedure. The study was supported in part by the Agency for Healthcare Research and Quality (HS16956).
See "The geographic availability and associated utilization of dual-energy X-ray absorptiomety (DXA) testing among older persons in the United States," by Jeffrey R. Curtis, M.D., Ph.D., Andrew Laster, M.D., David J. Becker, Ph.D., and others in the 2009 Osteoporosis International 20, pp. 1553-1561.