Analytical Report Performing Bone Density Studies in the Physician Office

¶ … Bone Density Studies

This reports presents research findings on the subject of bone density studies. A physician office wants to install bone density equipment but is not certain about types of machines to purchase and their price. This report therefore focuses on the available products and expert opinions in connection with that equipment. Cost of the bone density procedures and machines have also been briefly mentioned so that a physician would be able to estimate the possible costs involved and expected increase in revenues.

PRODUCTS RESEARCH

COSTS

INTERVIEW

This research has been conducted to find out what products are available in the market for bone density measurement. For the purpose of carrying out done density study, several key issues are to be carefully analyzed. Therefore in this research, we have focused on the available products, costs and insurance reimbursement. It has been found that there are not many physician-offices in the country engaged in bone density studies and therefore DEXA machines are usually found in large establishments. But a DEXA machine in the physician office can increase revenues manifold because of the cost of the procedure but most similar establishments are conducting bone density measurement procedures through scanners and ultrasound machines. This is because of the cost of the machines but if we focus on the revenues, there is a chance that ultimately law of diminishing costs would come into play and revenues would increase rapidly.

Methods and sources

For this research, we did not only look for available products in the market but also studied many periodicals and journals to see what experts had to say about such procedures. Our primary objective was to present a report that is based on sound expert advice and not only on our observations or conclusions. A survey and some interviews were also conducted so that we could find out what people had to say about bone density studies at a physician's office. The results of the survey have also been attached with the report.

INTRODUCTION

If a physician decides to conduct bone density studies at his office, the most important thing would be to first understand exactly what are the important bone density measurement methods and what products are available in the market for this purpose. On top of that, it would important to find out what patients think about having bone density procedures available at a physician's office. This is because it has been noticed that most hospital are offering this service on out patient basis and therefore people might wonder why a physician would want to carry out this procedure at his private clinic.

But it is not easy to simply get the machine and see revenues growing, this is because DEXA is a costly procedure and if an insurance plan is not covering it, there is a chance that people wouldn't want to opt for it. Secondly, it must be kept in mind that there are not many such machines available in the market and even when new and better machines are being manufactured, very few of them are available at private clinics. For this reason it would be ideal to go for low cost versions, which are usually available in portable forms but then there, is slight risk of inaccurate assessment.

Susan Brink (1996) writes, "A DEXA test costs $125 to $150, and only about half of insurers pay for it. Most Medicare carriers currently reimburse $110 to $120 of the cost. And with only about 2,000 DEXA machines in use in the United States, the device is not available everywhere. (The National Osteoporosis Foundation, can send a list of DEXA locations.) Another device, quantitative computed tomography, is a mini-CT scanner that produces sharp, three-dimensional images, but the test costs up to $300 and gives patients a higher dose of radiation than DEXA does. A lot of physicians prefer DEXA for the lower radiation dose."

Peak bone density

Menopause

Bone

Puberty osteopenia

Mineral osteoporosis

Density

AGE

The best reason a physician would want to have such services available at his office is because it will increase revenues. But the important thing in this regard is to know exactly what [products are available in the market and how much would they cost. Not only the cost has to be estimated but it must also be kept in mind that the maintenance of these machines can often be very costly. Therefore when revenues are being estimated everything from the cost of the product to its maintenance cost to the insurance etc. must be kept in view. In this study therefore we shall find out what products are out on the market and how much do they cost.

PRODUCT RESEARCH:

Norland manufactures some of the best products available for bone density measurement. The machines that any physician office would require for this procedure are easily available through this company but let us first mention what machines would be needed for this purpose. It has been noticed that mostly the machines required for this purpose. There are two types of procedures through which bone density can be measured. The first one being the DEXA method, which uses x-rays to measure bone density. X ray method is fast and painless and is partly covered by insurance. The other procedure is carried out through CT scan. Both these procedures would study the bone mineral density of patient's body and then compare it with a healthy person's bone density to find out if there is any risk of osteoporosis to the person.

There are several machines available for radiology procedure of DEXA (Dual Energy X-ray Absorptiometry). New and better machines keep coming into the market but it is important to understand exactly what kind of machines are best suited for a particular clinic. Because there is always a chance that one might for go a highly sophisticated machine and then find out that the cost of its purchase and maintenance is not exactly feasible for the person and instead of increasing the revenues, such machines can increase the cost of operations.

DEXA PROCEDURE

The reason why different types of machines are available is because not every physician would measure the bone density from the same area of the body. While it is known that mostly physicians measure bone density from lower spine or hip but there are machines that are specifically manufactured to measure bone density by gathering mass from forearm, heel and finger. There are thus several types of machines available in the market and it is good to check out all possible products before a physician decides to buy one.

Even though DEXA machine procedure costs between $150 and $300, it is better to invest in DEXA machine than it is to invest in an ultrasound product because while both can measure bone density, it has been found that only DEXA can do so accurately. But the ultra sound machines we are mentioning here are special products manufactured specifically for this purpose and therefore it either the physician should use both machines for accurate testing or he should invest only in a DEXA machine.

One DEXA machine called the DTX-200 is manufactured by Osteometer MediTech. This machine is believed to be fast and accurate in its testing procedures because it takes mass from forearm. Many physician offices are using the machine and they have reported satisfactory results. The machine is currently available for rental also but for that it is important to visit the authorized representatives of Osteometer Meditech.

DTX-200.

Complete details about the machine are available at the official site of the Osteometer Meditech. But here is brief description of the machine which has been directly taken from the web site of the manufacturer, "The DTX-200 DexaCare is a unique dual energy X-ray bone densitometer that gives you the opportunity to assess and follow up on the patients' bone density. With the DTX-200 DexaCare the physician has an easy and cost-effective method with a throughput of up to 50 examinations per working day. The DTX-200 DexaCare assesses forearm bone density with optimized precision and accuracy. One of the unique features of the DTX-200 DexaCare is the automatic identification of the 8 mm distance between ulna and radius. This ensures that the same area is assessed every time. The excellent in vivo accuracy (

But as we mentioned above there is a slight chance of inaccurate measurement and it should be kept in view when portable machines are being used. While DTX-200 is being used widely in many physician offices around the country, it would be best to consult various experts in this connection in order to know if having a portable machine is the only option available to a physician's office.

Susan Brink (1996) reports, "The pDEXA forearm densitometer, has the virtue of portability and the defect of selectivity. Some studies suggest that forearm tests don't precisely predict the fate of the hip or spine- -though many experts believe such a test is an acceptable first step. "If the only option is to look at only the forearm, I'd take it," says Susan Greenspan, director of the Osteoporosis Prevention and Treatment Center at Beth Israel Hospital in Boston. The pDEXA test is available in clinics and private doctors' offices."

It is also important to understand that while these machines may be cost-effective, there is slight chance of miscalculation, which may result in problems for the patients. The insurance companies are increasingly demanding physician offices to offer more services while many of them are not covered by insurance.

XCT-2000

Other important machines available for this purpose are ultrasound machines, which have been specifically manufactured for the purpose of bone density measurement. One such machine is XCT-2000. This machine is not exactly meant for DEXA and is actually an ultrasound scanner, which is considered ideal for small medical establishments specially a physician office. This machine is manufactured by Orthometrix and is available widely because of the fact that this is essentially a scanner. But what makes it different from other CT scans is that this machine offer the option of low radiation dose which is why DEXA method was always preferred to CT scans. This XCT-2000 has the capabilities of both a CT scan plus a low does x-ray and offers 'true volumetric measurement of bone density and can separate the Cortical shell from the Trabecular bone compartment for early detection of changes. The XCT 2000(TM) software facilitates location of the same scan site for study reproducibility. It also allows the physician to view the cross section of the bone for additional information.' http://www.orthometrix.net/

CT SCAN OF BONE MASS

While it is true that an ultra sound machine doesn't produce results as accurate as DEXA machine still it is important to understand that they are more feasible for physician's office. Secondly these machines can also increase revenues to certain extent if used properly. This is because if insurance plans do not cover DEXA machines, then people are more likely to opt for ultrasound, which costs less than $10. On the other hand, DEXA procedures cost more than $150 therefore only selected few patients would be able to afford it.

Susan Flagg Godbey (1997) writes, "Ultrasound's enormous potential as a convenient, inexpensive (maybe even $5 to $10) and reliable test could mean widespread osteoporosis screening, says Robert Lindsay, MD, president of the National Osteoporosis Foundation. "That kind of screening could give women the chance to take preventive measures, like boosting calcium, exercising and considering hormone- replacement therapy at menopause," he says. But ultrasound isn't the perfect test. An x-ray-based test (DEXA) is the only test that can see through the soft tissue around the hip and get a snapshot of what the bone density there is really like, says Dr. Lindsay. Ultimately, the combination of the two would be a superb bone test. Another hitch for now: Existing ultrasound machines cannot perform the heel test. This technology is not currently approved for osteoporosis screening in the United States, but experts here hope the French study spurs the FDA to reconsider it."

OTHER MACHINES AND COSTS:

Other machines include the ones that measure bone mass from specific peripheral sites such as fingers, heels and forearms. There are several machines available in the market for such procedures and therefore many physician offices prefer these smaller scanners to bigger EEXA machines. Besides costs of the procedures themselves, there are other reasons why some private offices may consider them more suitable. The costs of these machines is a big factor in selecting them, they costs usually around $11,000-$15,000 whereas a full DEXA machine is likely to cost more than $60,000. But the best thing about DEXA and all other machines is that they can easily be leased from authorized centers. The rental is not very high and machines are therefore become quite affordable. Rent is a good option especially if the machines are to be used for bone density studies. These machines are available in the market with names such as accuDEXA, PIXI, or p-DEXA.

INSURANCE COVERAGE FOR BONE DENSITY STUDIES:

It is important to understand that physicians office would be provided insurance coverage only if the studies are being conducted for specific purposes which have already been mentioned in the guidelines of every insurance company. These guidelines and the amount of reimbursement obviously vary from company to company but the most popular program is Medicare, which provides insurance for specific categories of studies.

For one it is felt that bone density studies should be carried out with patients who have certain bone related problem. It is absolutely not allowed to engage healthy people in the study because the research being carried out would be ineffective for them. Medicare specifically says that patients with certain conditions can be engaged in the study. Secondly, insurance converge is available if physician agrees to use the standard procedures and would only use FDA approved drugs during research. Thirdly, only FDA approved equipment can be used for this study.