[Congressional Record Volume 164, Number 109 (Thursday, June 28, 2018)]
[Senate]
[Page S4737]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself, Mr. Cardin, Mr. Wicker, Mr. King, 
        and Ms. Stabenow):
  S. 3160. A bill to amend title XVIII of the Social Security Act to 
improve access to, and utilization of, bone mass measurement benefits 
under part B of the Medicare program by establishing a minimum payment 
amount under such part for bone mass measurement; to the Committee on 
Finance.
  Mr. CARDIN. Mr. President, I rise today to introduce legislation with 
my colleague from Maryland, Senator Ben Cardin, which would increase 
access to preventive bone density screenings and improve osteoporosis 
diagnosis and treatment in the process. We are pleased to have Senators 
Wicker, King, and Stabenow as cosponsors.
  The public health risk of osteoporosis cannot be understated. Today, 
approximately 54 million Americans either have osteoporosis or low bone 
mass, which places them at increased risk for osteoporosis. Women are 
disproportionally affected, accounting for 71 percent of osteoporotic 
fractures and 75 percent of costs. Osteoporosis is often called ``the 
silent disease'' because bone loss usually occurs gradually over the 
years without symptoms.
  As the NIH Osteoporosis and Related Bone Disease National Resource 
Center observes, falls are especially dangerous for people who are 
unaware that they have low bone density. If the patient and the doctor 
fail to connect the broken bone to osteoporosis, the chance to make a 
diagnosis with a bone density test and begin a prevention or treatment 
program is lost.
  Early diagnosis and treatment of osteoporosis are proven to 
dramatically reduce fracture rates, and appropriate reimbursement for 
tests that measure bone mass and predict fracture risk are necessary to 
maintain patient access to care, particularly in rural or underserved 
areas. Our legislation, the Increasing Access to Osteoporosis Testing 
for Medicare Beneficiaries Act of 2018, tackles a proven barrier to 
proper screening by creating a floor reimbursement rate under Medicare 
for the dual energy X-ray absorptiometry (DXA) test, the ``gold 
standard'' for osteoporosis diagnosis.
  Congress has twice recognized the importance of reversing Medicare 
cuts to DXA reimbursement in order to maintain patient access, yet the 
Medicare reimbursement rate for DXA tests administered in a doctor's 
office has declined from $140 in 2006 to only $42 in 2018--a dramatic 
70 percent decline. The National Osteoporosis Foundation has found that 
declining reimbursement rates have created a 26 percent decline in 
physicians performing DXA tests since 2008, resulting in a 
corresponding 22 percent decline in diagnoses since 2009.
  Regrettably, as a result of reduced screenings due to declining 
reimbursements, it is estimated that more than 40,000 additional hip 
fractures occur each year, resulting in nearly 10,000 additional hip 
fracture-related deaths. As osteoporosis is already under-diagnosed in 
the Medicare population, it is clear that we must change this 
trajectory.
  This legislation is endorsed by the American Association of Clinical 
Endocrinologists, the National Osteoporosis Foundation, and more than 
forty additional national medical societies and patient advocate 
organizations. I thank Senator Cardin for joining me in this effort to 
increase patient access to osteoporosis screening and diagnosis, while 
lowering costs and consequences resulting from a lack of diagnosis. I 
encourage my colleagues to support its adoption.
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