Policy Widens Cancer Screening
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By Regina Nuzzo

Policy Widens Cancer Screening

Colonoscopies jump with Medicare expansion

By Regina Nuzzo


Medicare’s expanded reimbursements for colorectal cancer screening over the past decade have translated into benefits for patients, a recently published study suggests. Colonoscopy rates jumped substantially after the policy changes, and more patients with colorectal cancer have been diagnosed at early stages.

Because the Medicare policy changes arose directly from congressional mandates, these results “underscore the need for advocating Congress to promote cancer screening and prevention,” says Cary P. Gross, an internist at the Yale University School of Medicine in New Haven, Conn., and lead author of the study.

Colorectal cancer, the third most common cancer in the U.S., is expected to account for almost 10 percent of all cancer deaths in 2007. The American Cancer Society (ACS) recommends that patients 50 years and older get screened regularly for colorectal cancer with at least one of four available methods, such as colonoscopy. A 2000 study found, however, that fewer than half of Americans were following colorectal cancer screening guidelines.

In 1998, Medicare’s fee-for-service plan began to pay for colonoscopies to screen high-risk individuals; in 2001 it expanded coverage to include all beneficiaries. Gross and his colleagues, who published their results on Dec. 20, 2006, in the Journal of the American Medical Association, investigated the effects of these policies by examining the 1992–2002 records of Medicare enrollees 67 and older in the Surveillance, Epidemiology and End Results (SEER) database. These records included both Medicare health maintenance organization (HMO) members as well as Medicare fee-for-service beneficiaries, although the new reimbursement policies applied only to the latter group.

After full coverage began for fee-for-service beneficiaries in 2001, colonoscopy use among enrollees who had not been diagnosed with cancer grew to almost seven times the rate prior to reimbursement, the researchers found. Early detection increased, too. Between 1992 and 1997, an estimated 23 percent of colorectal cancer patients were diagnosed at an early stage. That figure rose to more than 26 percent after all enrollees were covered.

To ensure these changes weren’t due to other trends such as the so-called Katie Couric effect, which followed the news anchor’s televised colonoscopy in 2000, the researchers also examined a control group of HMO Medicare beneficiaries. Increases in early stage detection were found only in the population covered by the new Medicare reimbursements, Gross says.

The study helps to tease out complicated effects of Medicare policy, says epidemiologist Carrie Klabunde of the National Cancer Institute. But she cautions against interpreting the results too broadly. Other recommended colorectal cancer screening tools were not considered in the study, she points out.

Americans enrolled in private insurance plans have a growing number of options as well. Since 1998, 19 states, plus the District of Columbia, have passed legislation requiring private insurance companies to cover colorectal cancer screening tests in accordance with ACS guidelines, says Lisa Hughes, the director of policy and advocacy at the Cancer Research and Prevention Foundation, based in Alexandria, Va. The effects have already been noted: A 2006 ACS study found that colorectal cancer screening rates grew 40 percent faster in states with mandated coverage than in those without it. Other states are considering similar legislation, Hughes says.

“There are enough emotional barriers to getting a colonoscopy,” adds Carlea Bauman, the executive director of the advocacy organization C3: Colorectal Cancer Coalition, based in Washington, D.C. “If you throw in a financial barrier, it makes things even worse. Ultimately, we want this to be an affordable procedure for everyone.”