Overuse of short-interval bone densitometry: assessing rates of low-value care

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In February 2013, the American College of Rheumatology identified measuring bone density more often than once every 2 years as low-value care. This position was published as part of the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign. Drawing on HCFO-funded work, this article measured the prevalence and described the geographic variation of short-interval (repeated in under 2 years) dual-energy X-ray absorptiometry tests (DXAs) among Medicare beneficiaries and estimated the cost of this testing and its responsiveness to payment change. The researchers used Medicare claims data from 2006-2011 to identify DXA and short-interval DXAs for female Medicare beneficiaries over age 66. They found that overall DXA use was stable from 2008-2011 but DXA use did vary by hospital referral region. Results showed that short-interval DXA use fluctuated substantially with payment changes but other DXAs did not. This study suggests that carefully designed policy and payment reform may reduce overuse of DXAs.

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