It's time for CMS to cover virtual colonoscopy

Last week the American College of Radiology and the Colon Cancer Alliance called on Congress to pass the CT Colonography Screening for Colorectal Cancer Act, which would require Medicare to coverage beneficiaries for CT colonography--otherwise known as virtual colonoscopy.

In 2009, the Centers for Medicare & Medicaid Services decided it would not cover virtual colonoscopy, determining there wasn't sufficient evidence on the test characteristics and performance of the procedure in Medicare-aged individuals. CMS said that evidence wasn't sufficient enough to conclude that the procedure improves health benefits of asymptomatic, average-risk Medicare beneficiaries.

But things have changed since 2009.

First of all, it's becoming an increasingly popular alternative to traditional colon cancer screening methods. For example, virtual colonoscopy received a lot of publicity just a year after the CMS ruling came down when President Obama underwent the procedure during his annual physical (leaving observers to wonder why CMS was choosing not to cover a procedure that was suitable for the U.S. president).

One of the conundrums faced by medical policymakers regarding colon cancer screening is that despite that fact that it's tremendously successful at reducing the death rate associated with colon cancer, only about half of Americans over the age of 50 were getting screened. The Centers for Disease Control and Prevention estimates that about 30,000 deaths due to colon cancer could be prevented annually if everyone over the age of 50 was screened.

Now, however, we have evidence that the availability of the procedure increases screening rates. A study published in the Lancet Oncology in 2011 found that virtual colonoscopy increased screening rates by 55 percent. It seems self evident that a procedure that can increase colon cancer screening rates should be encouraged if we want to reduce the fatality rate associated with the disease. Research published in the January issue of the Journal of the American College of Radiology came to a similar conclusion.

What's more, some of the arguments against virtual colonoscopy are being undermined. For example, critics point out that virtual colonoscopy, like traditional colonoscopy, relies on patients successfully complying with a bowel-cleaning regimen before the procedure. But now there are laxative-free alternatives in the works that could make bowel cleansing unnecessary (and would probably increase screening rates).

The American Cancer Society endorses virtual colonoscopy as a screening option, and insurance companies like Cigna, UnitedHealthcare and Anthem Blue Cross Blue Shield cover it. Isn't it time for CMS to revisit the issue? - Mike  @FierceHealthIT

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