Illusory Promises of Future Health Care Cost Savings (and Increased Profits for Osteoporosis Screening Now!)

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The Boston Globe today has an excellent exploration of how lobbyists inserted language in the health care reform bill to effectively double payment for bone densitometry.   Medicare recognized that it was overpaying for osteoporosis screening tests, and cut prices.  Lobbyists for the scan manufacturers, physicians who perform scanning, and drug companies which sell osteoporosis medication cried "foul." As a result of a $3 million lobbying effort,  the price for a scan will go up from $50 to $97.

Here are two comments from (Democratic) legislators who got campaign contributions from the scanning industry and inserted this language into the health reform bill:

Representative Shelley Berkley (D-Nevada)

“You have to view these things through common sense. And it doesn’t take a genius to figure out that providing bone density tests for elderly Americans will save this country billions of dollars,’’ said  Berkley. “In addition to saving taxpayers money, it will prevent suffering that people with osteoporosis have.’’

Senator Blanche Lincoln (D- Arkansas)
“Part of her effort to strengthen and improve Medicare includes recognizing when a particular test with enormous potential to prevent health problems and significant promise of cost-savings is being taken out of doctors’ offices because providers can’t afford it,’’ said Lincoln spokeswoman Marni Goldberg. “That’s a flaw in the system that needs to be addressed.’’

The article notes that the cost of osteoporosis-related fractures is $19 billion per year. 

Both of these representatives are just plain wrong.   We should screen women at risk for osteoporosis - so that we can prevent fractures, prevent premature death, and give these women (and some men too) more Quality Adjusted Life Years (QALYs).   

However, when we make screening more available it costs more money.  It does not save money. In fact, depending on the analysis, each QALY saved by screening costs between $55,000 and $450,000.   Nothing wrong with doing screening.  But we should not offer false hope that this screening will save billions of dollars.