[Congressional Record Volume 157, Number 74 (Thursday, May 26, 2011)]
[Senate]
[Pages S3434-S3435]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE (for herself, Ms. Stabenow, Ms. Mikulski, Mr. 
        Cardin, and Mr. Wicker):
  S. 1096. A bill to amend title XVIII of the Social Security Act to 
improve access to, and utilization of, bone mass measurement benefits 
under the Medicare part B program by extending the minimum payment 
amount for bone mass measurement under such program through 2013; to 
the Committee on Finance.
  Ms. SNOWE. Mr. President, I rise today to join with Senator Stabenow 
of Michigan to introduce The Preservation of Access to Osteoporosis 
Testing for Medicare Beneficiaries Act of 2011. The companion bill in 
the U.S. House of Representatives is being introduced by Representative 
Michael Burgess with Representative Shelley Berkley.
  Since 1997, Congress has recognized the necessity of osteoporosis 
prevention by standardizing coverage for bone mass measurement under 
the Medicare program. At that time, I actively pursued inclusion of the 
language in the Medicare Bone Mass Measurement Standardization bill as 
part of the Balanced Budget Act of 1997. Later, with the passage of 
health care reform legislation, Congress enacted a temporary solution 
to the problem caused by Medicare cuts in reimbursement rates for 
osteoporosis screening tests through bone mass measurements. The 
osteoporosis screening provision in the Patient Protection and 
Affordable Care Act returned the Medicare reimbursement level to 70 
percent of the 2006 Medicare reimbursement rate.
  Regrettably, this provision will expire at the end of the calendar 
year. For Medicare beneficiaries, this sunset means that access to 
osteoporosis diagnosis, prevention, and treatment will once again be in 
jeopardy as Medicare reimbursement rates for osteoporosis screening 
will plummet by about 50 percent on January 1, 2012. Moreover, without 
adequate Medicare reimbursement rates, we most certainly risk losing 
the battle for improving access to bone density testing as well as 
preventing debilitating and costly bone fractures--an outcome we can 
ill afford.
  A disease of reduced bone mass that ultimately results in bones 
becoming brittle and fracturing more easily, osteoporosis constitutes a 
major public health threat, affecting 44 million Americans who either 
have the disease or are at risk for developing it due to low bone 
density. Osteoporosis is especially prevalent among women, who 
represent an incredible 71 percent of all cases. In fact, in their 
lifetime, one in two women and as many as one in four men over the age 
of 50 will fracture a bone due to osteoporosis. Amazingly, a woman's 
risk of an osteoporotic fracture is greater than her annual combined 
incidence of breast cancer, heart attack, and stroke, making access and 
affordability absolutely imperative.
  I want to stress to my colleagues that while there is no cure for 
osteoporosis, it is largely preventable and thousands of fractures 
could be avoided through early detection and treatment of low bone 
mass. New drug therapies have been proven to reduce fractures and to 
rebuild bone mass. At the same time, a bone mass measurement is 
necessary prior to initiating any form of osteoporosis therapy or 
prophylaxis.
  Bone mass measurements can be used to determine the status of a 
person's bone health and to predict the risk of future fractures. These 
tests are safe, painless, accurate, and quick. DXA, dual energy x-ray 
absorptiometry, is recognized by the World Health Organization, the 
U.S. Surgeon General, and the Centers for Medicare and Medicaid 
Services as the ``gold standard'' for diagnosing osteoporosis.
  A technique called vertebral fracture assessment or VFA can identify 
spinal fractures and show abnormally shaped vertebra. Bone density 
screenings have been shown to result in 37 percent reduction in hip 
fracture rates according to a 2008 study by Kaiser in Southern 
California. Reimbursement under the Medicare program for DXA screening 
is scheduled to be reduced by 62 percent by 2013 and VFA will be 
reduced by 30 percent by 2013. The reduction in Medicare reimbursement 
will almost certainly discourage physicians from continuing to provide 
convenient access to DXA screening or VFA in their offices.

  Since \2/3\ of all DXA scans are performed in non-facility settings, 
such as physician offices, patient access to bone mass measurement will 
continue to be severely compromised if DXA scans are not readily 
available to all patients. Our bill would renew the current Medicare 
levels for reimbursement relief to preserve access to DXA screenings, 
improve patient care, and prevent unnecessary costs to the Medicare 
program through reduced expenditures on fractures.
  Osteoporosis, which is responsible for more than two million 
fractures annually, is a silent disease that often goes undetected 
until a fall or an injury results in a broken bone. Our senior 
population is at greatest risk, with 89 percent of fracture costs 
attributed to individuals who are 65 years of age or older. Perhaps the 
most tragic consequences occur with elderly individuals who fall and 
suffer osteoporotic hip fractures.
  Of those senior citizens suffering hip fractures, 12-13 percent will 
die within 6 months following the injury and 20 percent will require 
nursing home care . . . often for the rest of their lives. Moreover, 
the Medicaid budget bears the cost of nursing home admissions

[[Page S3435]]

for hip fractures for low-income Americans. In general, osteoporotic 
fractures result in an estimated annual cost of $19 billion to our 
health care system.
  I remain hopeful that one day researchers will discover a cure for 
this silent and debilitating disease. In the meantime, early detection 
continues to be our best weapon against osteoporosis, because it is 
through early detection that we can best thwart the progress of 
osteoporosis by initiating preventive measures to combat bone loss.
  Continuing our current Medicare reimbursement rate for osteoporosis 
screening tests satisfies the triple aim of better care, improved 
health, and lower costs. I hope that our colleagues will join Senator 
Stabenow and me in supporting this bill.
                                 ______