At the critical time when our nation has made meaningful and measurable progress against colorectal cancer incidence, threats to reimbursement for colonoscopy screening for Medicare beneficiaries are looming, which may jeopardize the effectiveness of public health strategies to increase screening and prevention of colorectal cancer in the U.S.
New data from the American Cancer Society indicate that colorectal cancer has declined by 30% in just the last decade among those aged 50 or older. Much of that success is attributable to the widespread acceptance of colonoscopy and the expertise of the specialists who perform them — saving lives by detecting and removing dangerous pre-cancerous growths in the colon. We represent more than 12,000 of the nation’s gastroenterologists, and we are proud of the remarkable progress we have made in the fight against colorectal cancer.
However, despite the inroads being made against the second leading cause of U.S. cancer death, more must be done. Every year, an estimated 140,000 people are diagnosed with colorectal cancer and about 50,000 die from it. Half of these deaths could be prevented if people were screened regularly. As a nation, we must ensure that patients have access to quality colonoscopies. To help make this happen, colonoscopy screening is included as a preventive benefit within the Affordable Care Act and in every health plan, including Medicare.
While changing policies to expand patient coverage for preventive screenings, the U.S. government is also working to reform physician payments and rein in healthcare spending. The Centers for Medicare & Medicaid Services (CMS) are reducing physician reimbursements and doing so without being transparent in their process, methodology and activities.
Currently, Medicare pays gastroenterologists up to $220 on average for performing a colonoscopy, a tool that both diagnoses and treats potential symptoms of colorectal cancer. This fee includes the time, expertise and the clinical care gastroenterologists provide their patients before, during and after the procedure. If Medicare reimbursement rates don’t accurately reflect the value of this life-saving procedure, patient access may be limited for Americans who would benefit most.
Health care costs are high. The economics are highly complex, with government and insurance companies calling many of the shots. The cost of colonoscopies are not part of the problem — in fact, studies have found that the colonoscopy screening model translates into significant annual Medicare savings.
This is not just a narrow concern of gastroenterologists. Reimbursements are being reduced for orthopedic surgery, diagnostic radiology, pain management, urology and other specialties. Our country must get a handle on runaway health care costs, but every change should be carefully weighed for its impact on quality and patient access to care.
We believe that fully informed taxpayers and patients would better realize how cost-effective it is to have a highly trained physician take the time and effort needed to provide each person the best care possible. In the case of colonoscopy, the financial stakes are particularly high, because treating advanced colorectal cancer costs more than $250,000 per patient.
It is short-sighted and misguided to cut reimbursement for a screening test that is proven to prevent colorectal cancer, especially at a time when our nation is poised to take the fight against this deadly cancer to the next level. Our organizations have joined the American Cancer Society, several federal health agencies and other advocacy groups in an audacious goal to screen 80% of eligible American adults by 2018. That cannot happen if CMS risks short-term gains in exchange for longer-term liabilities in terms of costs of lives lost and costs to the U.S. healthcare system for colorectal cancer.
Harry E. Sarles, Jr. is president, American College of Gastroenterology, John I. Allen is president, American Gastroenterological Association, and Colleen M. Schmitt is president, American Society for Gastrointestinal Endoscopy.
