Getting DEXA to Pay

October 1, 2007

We purchased a DEXA machine three years ago. We have since downsized our practice by three physicians, but are still paying on the lease. We are having difficulty in getting enough of our own patients to pay for the machine. Do you have any suggestions about how we might get more use out of the equipment and/or offer it to other offices and still comply with the Stark laws? Or do you have any other suggestions to make the equipment pay for itself?

Question: We purchased a DEXA machine three years ago. We have since downsized our practice by three physicians, but are still paying on the lease. We are having difficulty in getting enough of our own patients to pay for the machine. Do you have any suggestions about how we might get more use out of the equipment and/or offer it to other offices and still comply with the Stark laws? Or do you have any other suggestions to make the equipment pay for itself?

Answer: Conduct an analysis to determine if it makes financial sense to sublease the machine. By moving it to another practice, you would open up space at your office, perhaps for another exam room.

Also make sure you are using the machine for every relevant patient. If you have an EMR, build in a prompt to order DEXA for every patient who meets the appropriate criteria (post-menopausal, history of anorexia, type 1 diabetes, hyperthyroidism, history of fractures, etc. - whatever the guidelines say).

Run reports for patients who might need DEXA but haven’t had one or haven’t had one recently. Invite them to visit the practice for the service.

For patients whose commercial plans don’t cover DEXA, consider charging cash.

You can market the fact that you offer the scans and get new patients that way, billing for all their care.

Consider getting a portable scan for the heel and taking it to health fairs or large employers. Invite the patients you identify who have some bone loss to visit your practice for a full scan.

It is possible to sublease the machine and avoid Stark implications, but you will want to poll an attorney. First, do a back-of-the-napkin analysis: how many more DEXAs could you expect if you were to share the equipment with another practice? Would the additional revenue cover the lease and the legal fees?