In some, especially rural areas, DXA testing is difficult to access. Because there are some areas where access to DXA is extremely limited, in these areas some have recommended automatically treating those that have a high clinical risk for fractures (Ito & Leslie, 2015, p. 2118). This possibility can also be seen as a challenge to changing the policy, because some think it is cheaper and more practical to just prophylactically treat high risk women. This fails to take into consideration possible side effects or adverse reactions from treatment. Another challenge to this policy change is that, while it is both potentially life saving and, eventually, very cost effective, this policy change is initially expensive and may meet resistance because of that. Approval for this policy requires an immediate government outlay of about $1 billion dollars in the first year alone. An additional challenge that he may face is a politically daunting one. Recently this author interviewed a local nurse leader and educator who had advocated for this policy change when speaking with an orthopedic surgeon friend of hers. When she suggested that he join the fight for this policy change, he gently laughed and asked, “Why would you think my profession would be motivated to help in this? Hip fractures are our bread and butter” (S. Striker, personal Page 11
Policy, Politics, and Global Health Many people who should be on the forefronts of this movement are, by the nature of what they do, are disincentivized to prioritize prevention. Primary Options and Interventions for Mr. Isakson Options or Alternatives - It’s also possible that Mr. Isakson sees other options or alternatives. There are a few outspoken groups that see routine DXA scan use as unnecessary and a poor allocation of already very limited resources (Muncie & Leblanc, 2010, para. 1). There are also some alternative tests to the DXA, though they are used less frequently. The Quantitative Computerized tomography or CT scan accurately shows bone density in the spine. But this is less accurate because possible previous damage to the spine can alter appearances. It is also more expensive and exposes the patient to higher doses of radiation (Yu, 2017, para. 16). Ultrasound is sometimes used, though less frequently, because of a lack of guidelines for ultrasound diagnostics or prediction of fracture risk (Yu, 2017, para. 17). The DXA is seen as the gold standard, and an increase in the floor for Medicare reimbursement seems to not only provide a lot of easy outcome for relatively little investment, it’s also something that will save Medicare a lot of money over the years to come. Proposal for a Persuasive Course of Action Steps - There a several steps that Mr. Isakson can take from here. One is to educate himself on the topic so that he knows he has his constituents’ best interest in mind. Another step he can take is to agree to support Ms. Collin’s Bill S.283 (Senate Bill 283, 2019). One of the Page 12
Policy, Politics, and Global Health
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- Winter '18
- National Osteoporosis Foundation