After years of congressional cost-cutting, colorectal cancer screening could be in line for a booster shot. A bill introduced in the U.S. Senate (S. 1164) would restore full Medicare reimbursement for approved colorectal cancer screening exams such as colonoscopy and flexible sigmoidoscopy.
Sponsored by Sen. Benjamin Cardin (D-MD) with bipartisan support, the measure would increase payments for colorectal cancer screening and diagnostic exams from 10% to 30% over current levels beginning January 1, 2008, bringing physician payments back in line with 1998 levels.
"In recent years, the Centers for Medicare and Medicaid Services has subjected colorectal cancer screening tests to some of the largest reimbursement reductions under the Medicare program," the bill states. Payment rates for screening have been cut by more than a third since the screening benefit was enacted in 1997; S. 1164 aims to restore screening reimbursement closer to the 1997 levels, Cardin states on his Web site.
One way the measure would increase reimbursement is by exempting colon screening procedures from the customary Medicare deductible requirement, whether or not the screening had a positive outcome. S. 1164 would also require Medicare to cover a preoperative visit to the physician's office before colonoscopy or other approved screening exam, such as flexible sigmoidoscopy or barium enema.
"Unlike other preventive screening tests covered under the Medicare Program, health care providers must consult with beneficiaries prior to furnishing a screening colonoscopy," in order to document the patient's medical history and prepare him or her for the screening procedure, the bill states. This prescreening consultation is not currently reimbursed.
Specifically, the measure would provide for national minimum payment amounts for CPT codes 45378, 45380, 45385, and HCPCS codes G0105 and G0121, reflecting a 10% increase above RVU values currently in effect for nonfacility rates. Facility rates for the same procedures would increase by 30%, and the bill provides for annual adjustments for both service categories.
The bill is co-sponsored by Sen. Susan Collins (R-ME), Sen. Joseph Lieberman (D-CO), Sen. Lindsey Graham (R-SC), and Sen. Benjamin Nelson (D-NE).
"Modern technology has given us the tools to save lives, but we must ensure that people have access to these lifesaving services," Cardin said in a statement announcing the bill. "This bill not only increases access to colon cancer screenings for millions of Americans, but will also save the Medicare system millions of dollars that would otherwise be spent on treating late-stage colon cancer."
There is some support in the literature for increasing colorectal cancer exam funding to increase screening compliance. A 2006 study examined the relationship between Medicare reimbursement and stage at diagnosis for older patients with colon cancer (Journal of the American Medical Association, 2006, Vol. 296:23, pp. 2815).
The study examined trends in colonoscopy use among Medicare beneficiaries before and after funding for colorectal cancer screening was increased in 1998. Screening compliance for optical colonoscopy increased from an average rate of 285/100,000 individuals per quarter from 1992-1997 (no coverage), to 889/100,000 per quarter from 1998-2001 (limited coverage, p < 0.001), and 1,919/100,000 per quarter from 2001-2002 (universal coverage, p versus the second period, < 0.001).
In addition, the reimbursement changes were strongly associated with earlier stage at diagnosis for patients who were eventually diagnosed with colon cancer. The proportion of patients diagnosed at an early stage increased from 22.5% to 25.5% to 26.3% in time periods 1-3, respectively.
"The selective effect of coverage change on proximal colon lesions suggests that increased use of whole-colon screening modalities such as colonoscopy may have played a pivotal role," authors Gross et al concluded. Compliance has fallen since funding was reduced, although the causes are debatable.
By Eric Barnes
AuntMinnie.com staff writer
April 30, 2007
Related Reading
Screening model calls VC most cost-effective colon exam, April 24, 2007
New developments improve VC -- and colonoscopy, April 6, 2007
Narrow-band imaging enhances diagnosis of colorectal tumors, March 23, 2007
Missed colorectal cancer rates higher with office-based colonoscopy, February 23, 2007
Disparities in colon cancer screening seen in Medicare population, February 13, 2007
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