Advocates outraged by CMS decision not to pay for virtual colonoscopies

It seems the recent decision by CMS to deny reimbursement of CT Colonoscopy for lack of evidence did not look at “ALL” of the facts, evidence, and costs related to colon cancer. It is easy to over look some of the data out there and then claim lack of evidence.

Below are some pertinent facts relating to colon cancer that somehow did not appear in the 30 page decision by CMS to deny coverage:

Fact: 50,000 people are dying from colon cancer each year in the US.
Fact: Another 150,000 new cases are being reported each year.
Fact: Sadly, all of this is from a cancer that is more than 90% preventable by early screening.
Fact: CMS and other healthcare providers are paying billions of dollars for the treatment of colon cancer each year
Fact: Optical colonoscopy is the only procedure where polyps (that can become a cancer) can be removed.
Fact: Any screening method is only effective when it is used.
Fact: More than 50% of the screening age population is simply not getting screened using the optical colonoscopy.
Fact: There is evidence that optical colonoscopy for screening is underutilized by CMS recipients – published papers
Fact: The GI community currently does not have the capacity to meet the needs of the screening population (generally those over the age of 50).
Fact: CMS pays for screening tests with lower sensitivity, such as the barium enema or flexible sigmoidoscopy. The flexible sigmoidoscopy is equated to having a mammography test of one breast.
Fact: There is evidence that CTC is cost-effective for screening
Fact: CTC screening programs over the past 5 years have shown as much as 70% increase in colon cancer screening compliance

For those who use the argument that if you have a polyp you need to go for an optical colonoscopy to get it removed anyway: Yes, that is true for medically significant polyps. However, the fact remains that if people are not getting screened (by any method) then no one will find and remove the polyps that could prevent colon cancer to begin with.

On the topic of polyp removal, only 10%-20% of the general screening age population need polyps removed. However, without effective screening no one will know who falls into that 10%- 20% group.

CT Colonoscopy offers a proven, economical, and viable option for colon cancer screening. There is plenty of evidence in published clinical trials over the past 10 years to show that CTC is as good as OC for detecting clinically significant polyps. The commercial health insurance carriers see the light and are beginning to reimburse for CTC screening.

The problem is that CMS cites that all this supporting data is on patients with an average age of 58, not 65 (Medicare age). If 10-20% of those being screened (at 58) have polyps that can turn into cancer, imagine how many 65 and over will have polyps that turn into cancer because they are NOT screened! Did CMS make a truly medical decision or a financial one by taking the easy way? Reimbursement for CT Colonoscopy now may increase some Medicare costs in the short-term, but would save enormous amounts later by significantly reducing the cost of treating colon cancer. Is CMS “passing the buck” to control their spending now vs. investing in the future?

On one hand, our government talks about preventative health care, on the other, we are paying billions of dollars for treating colon cancer now but do nothing to improve prevention of the disease even when it is available. The reality is that optical colonoscopy is not working as it should for colon cancer prevention. Should we ignore this problem by choosing to accept it, or do something about it in a proactive manner? Maintaining status quo, as CMS has done, is really not the option to choose.

Patients are living longer.We are now grappling with fit 93 yr old patients who have rectal bleeding.I would favour a virtual colonoscopy over a regular one since the patient would not be subject to the risks of sedation.This is a slap in the face for seniors.The life expectancy for this century is 140 years.