AACE LEGISLATIVE FACT SHEET

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1 AACE LEGISLATIVE FACT SHEET INCREASING ACCESS TO OSTEOPOROSIS TESTING FOR MEDICARE BENEFICIARIES ACT (H.R. 1898/S. 3160) REQUEST: Please co-sponsor this legislation that provides a sustainable Medicare payment for dual energy x-ray absorptiometry (DXA) bone density scans performed in a physician s office to help preserve beneficiary access to osteoporosis testing, prevention and treatment services. WHAT ARE OSTEOPOROSIS TESTING, PREVENTION AND TREATMENT SERVICES? Osteoporosis causes bones to become brittle and porous, which causes bones to break. Osteoporosis testing is done by measuring bone density with a dual energy x-ray absorptiometry (DXA) machine. A DXA test identifies those who are at high fracture risk and is also used to monitor effectiveness of medical therapy to prevent and treat osteoporosis. DXA is considered the gold standard for osteoporosis testing by the medical community. WHY IS MAINTAINING ACCESS TO THESE SERVICES SO IMPORTANT? 54 million Americans have low bone density or osteoporosis. Approximately one in two women and up to one in four men over the age of 50 will break a bone due to osteoporosis. In fact, 25% of women over the age of 50 who sustain a hip fracture die in the year following the fracture, 50% never walk independently again and 20% require permanent nursing home placement, at an enormous cost to government health programs. Medicare paid over $16 billion in 2010 for direct costs of new fractures and that number is projected to grow to over $25 billion by Older women who have a DXA have 35% fewer hip fractures than those who are not tested A DXA bone density test is now covered every 2 years as part of the Medicare Annual Wellness Visit, in addition to being part of the Welcome to Medicare exam Incentives for beneficiaries to utilize preventive health services, like a DXA test, will be meaningless if patients cannot access this service in their communities. ISSUE: Medicare reimbursement for DXA has dropped from $140 in 2007 to $42 in 2018 a payment reduction of 70%. Current payment rates do not cover the physician cost of providing these services, and as a result the capacity to provide DXA services within the healthcare system is being reduced and fewer women are being tested. Direct Research LLC, Medicare PSPS Master Files and Medicare 5 Percent Sample LDS SAF, analysis by Peter M. Steven, PhD. AACE urges Congress to pass legislation that provides a sustainable Medicare payment rate for high quality osteoporosis testing, prevention and treatment services to reduce fracture risk and the number of hip, back and wrist fractures in older Americans. September 2018

2 AACE LEGISLATIVE FACT SHEET COSPONSOR THE TREAT AND REDUCE OBESITY ACT (H.R. 1953/S. 830) Request: Please cosponsor the Treat and Reduce Obesity Act of This legislation seeks to effectively treat and reduce obesity by enhancing Medicare beneficiary access to endocrinologists and other healthcare professionals that are best suited to provide intensive behavioral therapy (IBT) and by allowing Medicare Part D to cover FDA-approved obesity drugs. The Problem: Obesity is a public health crisis that strains our nation s economy. Obesity rates have doubled among adults over the last twenty years 35% of adults are living with obesity and an additional 33% are overweight Obesity accounts for 21% of total national healthcare spending Medicare and Medicaid patients with obesity cost $61.8 billion per year; eradicating obesity would result in an 8.5% savings in Medicare spending alone. Evidence suggests that without concerted action, roughly half the adult population will have obesity by Research studies document the harmful health effects of excess body weight, which increases the risk for conditions such as diabetes, hypertension, heart failure, dyslipidemia, sleep apnea, hip and knee arthritis, multiple cancers, renal and liver disease, musculoskeletal disease, asthma, infertility and depression. Current Barriers to Effective Obesity Treatment: Medicare Intensive Behavioral Therapy (IBT) Coverage Policy IBT consists of measurement of Body Mass Index (BMI), dietary/nutritional assessments and intensive behavioral counseling that promotes sustained weight loss through high intensity (i.e., regular and frequent) diet and exercise interventions. The United States Preventive Services Task Force (USPSTF) concluded that these interventions are an effective component in obesity management and improve glucose tolerance, blood pressure and other risk factors for cardiovascular disease. Unfortunately, when Medicare implemented a national coverage decision on IBT in 2012, the policy only covered these services when provided by a primary care provider. Because of this narrow coverage decision, healthcare providers with special training in obesity treatment, such as endocrinologists, nutrition professionals and other specialists, are prevented from effectively providing IBT services. Medicare Part D Coverage of Obesity Medications When Congress enacted the Medicare Part D Prescription Drug Program there were no widely accepted FDA-approved obesity therapies on the market. This fact, combined with the false perception at that time that obesity was a lifestyle condition, led Congress to prevent Medicare Part D from covering weight loss drugs. Over the last 10 years, significant medical advances have been made in the development of obesity medications. That fact combined with our country s current and growing obesity epidemic, clearly make the Part D statute out of date and out of touch with the current scientific evidence surrounding these new pharmaceutical treatments. Since the enactment of Medicare Part D, the FDA has approved a number of new obesity medications and several other promising therapies are quickly progressing through the agency s approval process. The Solution: The Treat and Reduce Obesity Act gives CMS the authority to enhance beneficiary access for IBT by allowing additional types of qualified health care providers with special training in obesity management to offer IBT services. TROA also gives the Medicare Part D program the authority to cover FDA-approved weight loss medications that complement IBT. The bill provides cost-effective coordinated interdisciplinary care to address obesity. To co-sponsor this bill, please contact Andy Franke with Representative Paulsen (R-MN), Alex Eveland with Representative Kind (D-WI), Matt Gallivan with Senator Cassidy (R-LA) or Lynn Sha with Senator Carper (D- DE). March 2018

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5 INCREASING ACCESS TO DXA BONE DENSITY SCANS (H.R. 1898/S. 3160) Patient access to DXA bone density screening is critical to efforts to prevent bone fractures and osteoporosis 25% of women over the age of 50 who sustain a hip fracture die in the year following the fracture, 50% never walk independently again and 20% require permanent nursing home placement In 2010, Medicare paid $16 billion for direct costs of new fractures. This figure is projected to grow to over $25 billion per year by 2025 Women 65+ who have a DXA bone density scan have 22% fewer fragility fractures and 35-50% fewer hip fractures than those who do not Following Medicare s 70% cuts to DXA, beginning in 2007 (from $140 to $42 today), there have been fewer DXA providers overall (approximately 30% less) and declining DXA testing rates (2.8 million fewer women tested ) Refer to graphs on fact sheet Federal prevention efforts will fail if these trends are not reversed Request co-sponsorship of H.R. 1898/S. 3160, Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act This bipartisan bill provides a reasonable Medicare payment rate for DXA, raising the nat l average payment from $42 to $98. To cosponsor contact Meghan Stringer/Rep. Blackburn or Sylvia Lee/Rep. Larson; Amy Pellegrino/Sen. Collins or Lauren Jee/Sen. Cardin TREAT AND REDUCE OBESITY ACT (H.R. 1953/S. 830) Request co-sponsorship of the Treat & Reduce Obesity Act (TROA) $1.42 Trillion spent in U.S. annually on direct and indirect costs of health conditions related to obesity. Nearly 1 in 3 Medicare beneficiaries affected by obesity, however less than 1% of Medicare beneficiaries with obesity can access obesity care. Too few providers of Intensive Behavioral Therapy (IBT); Medicare only covers IBT provided by a primary care provider (PCP) in a primary care setting. Contradicts USPSTF evidence report stating PCPs are limited in time, training and skills to provide IPT that is evidence-based and produces best results. TROA removes barriers that prevent endocrinologists and other HCPs with specialized obesity training from providing IBT. Will allow practitioners to independently provide services outside of the primary care setting. TROA also authorizes Medicare coverage for FDA-approved weight loss drugs that compliment IBT, which are currently prohibited under Part D Drug Program. Obesity now recognized by medical community as a disease and should be treated as such (AACE resolution at 2013 AMA House of Delegates mtg) Bipartisan bill: To co-sponsor contact Andy Franke/Rep. Paulsen or Alex Eveland/Rep Kind; Matt Gallivan/Sen. Cassidy or Lynn Sha/Sen. Carper