Should CMS reimburse for CTC?

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Mike Bassett Associate Editor

Did the Centers for Medicare & Medicaid Services (CMS) make a mistake last year when it decided it would not reimburse for CT colonography (CTC)?

The question continues to roil the healthcare community, and the publication of an article this month in Radiology showing that CTC is a safe and effective screening modality for the elderly seems to ensure the issue won’t go away any time soon.

The retrospective study by David Kim, MD, associate professor of radiology at the University of Wisconsin’s School of Medicine and Public Health in Madison, and colleagues, found that the use of CTC in 577 patients aged 65 to 79 produced low referral-for-colonoscopy rates similar to other screening tests covered by Medicare and doesn’t result in an excessive additional testing because of extracolonic findings.

"There have been questions raised that factors such as the [colonoscopy] referral rate and extracolonic work up rates would be too high in an older population for CT colonography to be a cost-effective, frontline CRC screening exam,” said Kim. “Our results suggest otherwise and that these rates remain in a reasonable range.”

In a letter to the editor in this month’s Journal of the American College of Radiology, Arnold C. Friedman, MD, and Peter Lance, MD, radiologists from the University of Arizona School of Medicine, called CMS’s decision not to reimburse “misguided and shortsighted,” suggesting that CTC is an effective screening alternative that many Medicare-eligible persons –who for some reason have rejected optical colonoscopy--would choose if it were reimbursed. The CMS has argued that there is no solid evidence that making CTC reimbursable would increase screening rates.

The arguments about the CMS' CTC reimbursement decision will probably continue, particularly as healthcare professionals argue the merits of CTC and optical colonoscopy when it comes to the issues of cost efficiency and effectiveness.

Nevertheless, Kim believes the results of his study demonstrates CTC is worth another look concerning its use on the elderly.

"The lack of complications, particularly no perforations, attests to the safety of this procedure even in the older population,” he wrote. “Given what we know of the increasing risk for complications for optical colonoscopy in older patients, perhaps we should consider CT colonography more strongly in this particular group.”

If you have a comment or report to share about how the utilization of advanced visualization technology is changing your practice, please contact me at the address below. I look forward to hearing from you.

Michael Bassett, Associate Editor